Relationship Between Case Volume and Outcomes for Pulmonary Resection for Lung Cancer at Safety-Net Hospitals

Area of Science:

• Health Services Research
• Surgical Oncology
• Health Equity

Background:

• Safety-net hospitals (SNHs) face challenges in perioperative care for pulmonary resections, potentially due to diagnostic delays and inefficient pathways.
• Surgical volume is a known factor for improving outcomes in pulmonary resections within integrated systems, but its impact at SNHs remains unclear.

Purpose of the Study:

• To investigate the association between surgical volume and patient outcomes for elective lung cancer lobectomy at SNHs.
• To determine if higher surgical caseloads at SNHs can mitigate perioperative morbidity and financial burdens.

Main Methods:

• Analysis of the Nationwide Readmissions Database (2016-2021) for adult patients undergoing elective lung cancer lobectomy.
• Definition of SNHs based on the top quartile of Medicaid or self-pay/uninsured admissions.
• Stratification of SNHs into low (<10), medium (10-33), and high (>33 cases/year) lobectomy volume categories.

Main Results:

• Care at high-volume SNHs was linked to significantly lower rates of major morbidity, respiratory complications, and blood transfusions.
• High-volume centers also reduced the likelihood of non-home discharge and decreased hospitalization duration and overall costs.
• Adjusted odds ratios (AOR) for major morbidity: 0.81; respiratory complications: 0.79; blood transfusion: 0.67; non-home discharge: 0.66.

Conclusions:

• Increased surgical volume at safety-net hospitals is associated with improved clinical and financial outcomes for pulmonary resections.
• Patients treated at high-volume SNHs experience better results, suggesting that surgical caseload is a critical factor in overcoming SNH-related challenges.