Erik M von Meyenfeldt1, Geertruid M H Marres1, Eric van Thiel2, Ronald A M Damhuis3. 1. Department of Thoracic Surgery, Lung Cancer Centre, Albert Schweitzer Hospital, Dordrecht, Netherlands. 2. Department of Thoracic Oncology, Lung Cancer Centre, Albert Schweitzer Hospital, Dordrecht, Netherlands. 3. Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, Netherlands.
Abstract
OBJECTIVES: Length of stay (LOS) in the hospital after lung cancer surgery is influenced by patient characteristics, tumour characteristics, surgical technique and perioperative care. Our objective was to determine whether there were variation in LOS between hospitals that could not be accounted for by these known parameters. Residual variation in LOS would suggest important differences in perioperative care protocols and discharge criteria. METHODS: This study analysed data from the Netherlands National Cancer Registry (NNCR) on 10 195 anatomical lung resections for primary lung cancer from 2010 to 2015. Multivariable analysis was performed for multiple factors, using hierarchical linear regression analysis of the mean LOS. Information on comorbidity and socio-economic status was not available. Association between LOS and postoperative mortality was evaluated in multivariable logistic regression. RESULTS: The median LOS was 7 days (interquartile range 5-10 days), and the mean LOS was 8.3 days. LOS was negatively affected by larger resections, open surgery and advancing age. Histology and tumour stage had little influence. Overall, 30-day and 90-day mortality were 2.1% and 3.8%, respectively; 1.7% and 3.3% (not significant) in the group of hospitals with shorter LOS. After case-mix correction, residual between-hospital variation in the mean LOS was observed, ranging from 1.5 days shorter to almost 2.5 days longer. CONCLUSIONS: A clinically relevant between-hospital variation in LOS after lung cancer surgery is observed in the Netherlands. Although residual confounding by comorbidity or socio-economic status cannot be excluded, this variation is deemed to be largely due to differences in perioperative care protocols. Evaluation of best practices can help to improve perioperative care for lung surgery patients and optimize LOS.
OBJECTIVES: Length of stay (LOS) in the hospital after lung cancer surgery is influenced by patient characteristics, tumour characteristics, surgical technique and perioperative care. Our objective was to determine whether there were variation in LOS between hospitals that could not be accounted for by these known parameters. Residual variation in LOS would suggest important differences in perioperative care protocols and discharge criteria. METHODS: This study analysed data from the Netherlands National Cancer Registry (NNCR) on 10 195 anatomical lung resections for primary lung cancer from 2010 to 2015. Multivariable analysis was performed for multiple factors, using hierarchical linear regression analysis of the mean LOS. Information on comorbidity and socio-economic status was not available. Association between LOS and postoperative mortality was evaluated in multivariable logistic regression. RESULTS: The median LOS was 7 days (interquartile range 5-10 days), and the mean LOS was 8.3 days. LOS was negatively affected by larger resections, open surgery and advancing age. Histology and tumour stage had little influence. Overall, 30-day and 90-day mortality were 2.1% and 3.8%, respectively; 1.7% and 3.3% (not significant) in the group of hospitals with shorter LOS. After case-mix correction, residual between-hospital variation in the mean LOS was observed, ranging from 1.5 days shorter to almost 2.5 days longer. CONCLUSIONS: A clinically relevant between-hospital variation in LOS after lung cancer surgery is observed in the Netherlands. Although residual confounding by comorbidity or socio-economic status cannot be excluded, this variation is deemed to be largely due to differences in perioperative care protocols. Evaluation of best practices can help to improve perioperative care for lung surgery patients and optimize LOS.
Authors: Won Gi Jeong; Yun-Hyeon Kim; Jong Eun Lee; In-Jae Oh; Sang Yun Song; Kum Ju Chae; Hye Mi Park Journal: Cancer Res Treat Date: 2021-09-28 Impact factor: 5.036
Authors: Christine M Cramer-van der Welle; Lotte van Loenhout; Ben Eem van den Borne; Franz Mnh Schramel; Lea M Dijksman Journal: BMJ Open Date: 2021-01-15 Impact factor: 2.692
Authors: Erik M von Meyenfeldt; Femke van Nassau; Carlijn T I de Betue; L Barberio; Wilhelmina H Schreurs; Geertruid M H Marres; H Jaap Bonjer; Johannes Anema Journal: BMJ Open Date: 2022-01-05 Impact factor: 2.692