Association Between Utilization of Services and Perioperative Outcomes for Lung Cancer Resection

Area of Science:

• Thoracic Surgery
• Health Services Research
• Oncology

Background:

• Lung cancer resection outcomes traditionally focus on perioperative mortality.
• Variations in perioperative outcomes and service utilization (ambulatory, inpatient) are known.
• The association between these two factors for benchmarking provider performance is underexplored.

Purpose of the Study:

• To evaluate the association between perioperative outcomes and healthcare service utilization in lung cancer resection.
• To assess provider performance in lung cancer surgery using a broader context of care.

Main Methods:

• Retrospective cohort study of 15,168 patients undergoing lung cancer resection (2017-2019) across 297 hospitals.
• Hierarchical logistic regression used for risk- and reliability-adjusted mortality and service utilization.
• Service utilization analyzed across quartiles of perioperative mortality.

Main Results:

• Mean risk-adjusted 90-day mortality varied across quartiles (1.58% to 2.74%).
• Highest utilization of ambulatory procedures (37.7%) was observed in the lowest mortality quartile.
• Lowest inpatient utilization pre- (15%) and post-surgery (19.3%) occurred in the best-performing quartile.

Conclusions:

• Hospitals with lower perioperative mortality for lung cancer resection trend towards greater outpatient resource use and less inpatient service utilization.
• This correlation underscores the need to integrate service utilization metrics with mortality data for comprehensive provider profiling.
• Evaluating both outcomes and utilization offers a more complete picture of efficiency and effectiveness in lung cancer care centers.