[Accepted Manuscript] High lung cancer surgical procedure volume is associated with shorter length of stay and lower risks of re-admission and death: National cohort analysis in England.

Article English OPEN
Møller, H. ; Riaz, S.P. ; Holmberg, L. ; Jakobsen, E. ; Lagergren, J. ; Page, R. ; Peake, M.D. ; Pearce, N. ; Purushotham, A. ; Sullivan, R. ; Vedsted, P. ; Luchtenborg, M.

It is debated whether treating cancer patients in high-volume surgical centres can lead to improvement in outcomes, such as shorter length of hospital stay, decreased frequency and severity of postoperative complications, decreased re-admission, and decreased mortality. <br/><br/>The dataset for this analysis was based on cancer registration and hospital discharge data and comprised information on 15,738 non-small cell lung cancer patients resident and diagnosed in England in 2006-2010 and treated by surgical resection. The number of lung cancer resections was computed for each hospital in each calendar year, and patients were assigned to a hospital volume quintile on the basis of the volume of their hospital.<br/><br/>Hospitals with large lung cancer surgical resection volumes were less restrictive in their selection of patients for surgical management, and provided a higher resection rate to their geographical population. Higher volume hospitals had shorter length of stay and the odds of re-admission were 15% lower in the highest hospital volume quintile compared with the lowest quintile. Mortality risks were 1% after 30 days and 3% after 90 days. Patients from hospitals in the highest volume quintile had about half the odds of death within 30 days than patients from the lowest quintile.<br/><br/>Variations in outcomes were generally small, but in the same direction, with consistently better outcomes in the larger hospitals. This gives support to the ongoing trend towards centralisation of clinical services, but service re-organisation needs to take account of not only the size of hospitals but also referral routes and patient access.
  • References (59)
    59 references, page 1 of 6

    study in England 2004-2006. Eur J Cancer. 2012 Jan;48(1):54-60. doi:

    10.1016/j.ejca.2011.07.012. Epub 2011 Aug 24. PubMed PMID: 21871792. 10. Walters S, Benitez-Majano S, Muller P, Coleman MP, Allemani C, Butler J, Peake M,

    international gap in cancer survival? Br J Cancer. 2015 Sep 1;113(5):848-60. doi:

    10.1038/bjc.2015.265. Epub 2015 Aug 4. PubMed PMID: 26241817; PubMed Central

    PMCID: PMC4559829. 11. Lüchtenborg M, Riaz SP, Coupland VH, Lim E, Jakobsen E, Krasnik M, Page R, Lind MJ,

    survival after lung cancer surgery. J Clin Oncol. 2013 Sep 1;31(25):3141-6. doi:

    10.1200/JCO.2013.49.0219. Epub 2013 Jul 29. PubMed PMID: 23897962. 12. National Lung Cancer Audit

    https://www.rcplondon.ac.uk/projects/national-lung-cancer-audit 13. Cheung MC, Hamilton K, Sherman R, Byrne MM, Nguyen DM, Franceschi D, Koniaris LG.

    resection: an examination of 13,469 surgical patients. Ann Surg Oncol. 2009 Jan;16(1):3-

    13. doi: 0.1245/s10434-008-0025-9. Epub 2008 Jul 4. PubMed PMID: 18600379. 14. Learn PA, Bach PB. A decade of mortality reductions in major oncologic surgery: the

  • Metrics
    No metrics available
Share - Bookmark