A Laurie Shroyer1, Jacquelyn A Quin2, Maria V Grau-Sepulveda3, Andrzej S Kosinski3, Babatunde A Yerokun3, John D Mitchell4, Thomas V Bilfinger5. 1. Stony Brook University School of Medicine, Stony Brook, NY. Electronic address: annielaurie.shroyer@stonybrookmedicine.edu. 2. VA Boston Healthcare System, Boston, Massachusetts. 3. Duke Clinical Research Institute, Durham, North Carolina. 4. University of Colorado School of Medicine, Aurora, Colorado. 5. Stony Brook University School of Medicine, Stony Brook, NY.
Abstract
BACKGROUND: Lung cancer ranks as the top cancer killer in the United States. Using The Society of Thoracic Surgeons General Thoracic Surgery Database (GTSD), the geographic variability of lung cancer lobectomy for operative mortality and major morbidity were examined. METHODS: From January 2009 to June 2015, the GTSD lung cancer lobectomy records (excluding robotic procedures) were assigned to a US Census region using hospital location. Surgeons performing fewer than seven lung cancer lobectomies per year were categorized as "low volume." The American College of Surgeons Oncology Group criteria were used to classify patients as "high risk." Applying the published GTSD risk algorithms, regional unadjusted and adjusted odds ratios were computed using univariable and multivariable generalized estimating equation logistic regression. Across geographic regions, patient risk factors and outcomes were compared using Kruskal-Wallis and χ2 tests. RESULTS: From 2009 to 2015, there were 39,078 lung cancer lobectomies that met study inclusion criteria (31.5% Northeast, 23.5% Midwest, 31.1% South, and 14.0% West). Fewer high-risk cases were seen in the West region (18.9% Northeast, 19.6% Midwest, 19.9% South, and 15.9% West; p < 0.001). Across geographic regions, there was no statistically significant difference in the proportion of low-volume surgeons (39.8% Northeast, 44.8% Midwest, 45.8% South, and 56.3% West; p = 0.0512). Adjusted odds ratios for operative mortality and major perioperative morbidity did not show statistically significant differences across regions (p = 0.761 and p = 0.600, respectively). CONCLUSIONS: Despite geographic variations in the proportion of high-risk lobectomies, the risk-adjusted mortality and morbidity outcomes did not vary by region.
BACKGROUND:Lung cancer ranks as the top cancer killer in the United States. Using The Society of Thoracic Surgeons General Thoracic Surgery Database (GTSD), the geographic variability of lung cancer lobectomy for operative mortality and major morbidity were examined. METHODS: From January 2009 to June 2015, the GTSD lung cancer lobectomy records (excluding robotic procedures) were assigned to a US Census region using hospital location. Surgeons performing fewer than seven lung cancer lobectomies per year were categorized as "low volume." The American College of Surgeons Oncology Group criteria were used to classify patients as "high risk." Applying the published GTSD risk algorithms, regional unadjusted and adjusted odds ratios were computed using univariable and multivariable generalized estimating equation logistic regression. Across geographic regions, patient risk factors and outcomes were compared using Kruskal-Wallis and χ2 tests. RESULTS: From 2009 to 2015, there were 39,078 lung cancer lobectomies that met study inclusion criteria (31.5% Northeast, 23.5% Midwest, 31.1% South, and 14.0% West). Fewer high-risk cases were seen in the West region (18.9% Northeast, 19.6% Midwest, 19.9% South, and 15.9% West; p < 0.001). Across geographic regions, there was no statistically significant difference in the proportion of low-volume surgeons (39.8% Northeast, 44.8% Midwest, 45.8% South, and 56.3% West; p = 0.0512). Adjusted odds ratios for operative mortality and major perioperative morbidity did not show statistically significant differences across regions (p = 0.761 and p = 0.600, respectively). CONCLUSIONS: Despite geographic variations in the proportion of high-risk lobectomies, the risk-adjusted mortality and morbidity outcomes did not vary by region.
Authors: Amelia W Maiga; Stephen A Deppen; Jason Denton; Michael E Matheny; Erin A Gillaspie; Jonathan C Nesbitt; Eric L Grogan Journal: JAMA Surg Date: 2019-06-01 Impact factor: 14.766
Authors: Oscar Peñuelas; Alfonso Muriel; Victor Abraira; Fernando Frutos-Vivar; Jordi Mancebo; Konstantinos Raymondos; Bin Du; Arnaud W Thille; Fernando Ríos; Marco González; Lorenzo Del-Sorbo; Niall D Ferguson; Maria Del Carmen Marín; Bruno Valle Pinheiro; Marco Antonio Soares; Nicolas Nin; Salvatore M Maggiore; Andrew Bersten; Pravin Amin; Nahit Cakar; Gee Young Suh; Fekri Abroug; Manuel Jibaja; Dimitros Matamis; Amine Ali Zeggwagh; Yuda Sutherasan; Antonio Anzueto; Andrés Esteban Journal: Intensive Care Med Date: 2020-01-07 Impact factor: 41.787