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Pneumonectomy for Lung Cancer Treatment in The Netherlands: Between-Hospital Variation and Outcomes
Naomi Beck1,2, Thomas J van Brakel3, Hans J M Smit4
1Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. n.beck@lumc.nl.
World Journal of Surgery
|September 25, 2019
Summary
Pneumonectomy use for lung cancer varies significantly across Dutch hospitals, with some performing more procedures than expected, leading to higher complication rates. This highlights the need for standardized care and hospital-specific feedback to improve patient outcomes.
Area of Science:
- Thoracic surgery
- Surgical oncology
- Public health
Background:
- Pneumonectomy, a major lung cancer surgery, carries high risks.
- Its utilization varies, but patterns of use across hospitals are not well understood.
- This study investigates variations in pneumonectomy rates for primary lung cancer in the Netherlands.
Purpose of the Study:
- To examine the variation in pneumonectomy use among hospitals in the Netherlands for primary lung cancer treatment.
- To identify factors associated with pneumonectomy utilization.
- To assess if higher pneumonectomy rates correlate with increased complications.
Main Methods:
- Utilized data from the Dutch Lung Cancer Audit for Surgery (2012-2016).
- Employed multivariable logistic regression to identify factors influencing pneumonectomy use.
- Calculated observed/expected (O/E) ratios to compare hospital-specific pneumonectomy rates.
Main Results:
- Of 8446 patients, 7.8% underwent pneumonectomy, with a 7.1% mortality rate.
- Factors like age, gender, comorbidities, and tumor characteristics influenced pneumonectomy decisions.
- Significant hospital variation in pneumonectomy use was observed (IQR 5.5-10.1%), with some hospitals performing significantly more procedures than expected, associated with higher severe complication rates.
Conclusions:
- Considerable between-hospital variation exists in pneumonectomy rates for lung cancer.
- Center-specific feedback on pneumonectomy use is recommended.
- Development of a risk-adjusted pneumonectomy indicator is suggested to optimize surgical care.
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