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Impact of teaching facility status and high-volume centers on outcomes for lung cancer resection: an examination of 13,469 surgical patients.
- Source :
-
Annals of surgical oncology [Ann Surg Oncol] 2009 Jan; Vol. 16 (1), pp. 3-13. Date of Electronic Publication: 2008 Jul 04. - Publication Year :
- 2009
-
Abstract
- Background: Studies suggest that institutional case volume and teaching status significantly affect patient survival. We sought to compare outcomes of surgical resection for lung cancer at teaching facilities (TF) and at high-volume centers (HVC).<br />Methods: Patients undergoing lung cancer resection with curative intent were examined using a linked dataset from 1998 to 2002 between the Florida Cancer Data System and the Florida Agency for Health Care Administration.<br />Results: A total of 13,469 patients were analyzed and outcomes adjusted for comorbidities. Median survival time (MST) was superior for patients treated at TF versus nonteaching facilities (NTF) (47.1 versus 40.5 months, P < 0.001). Mortality rates at NTF were higher at 30 days (2.6% versus 1.1%, P < 0.001), 90 days (6.8% versus 3.8%, P < 0.001), and at 5 years (63.9% versus 59.2%, P = 0.005). Similarly, MST was superior in the cohort treated at HVC versus low-volume center (LVC) (45.1 versus 39.8 months, P < 0.001). Mortality was observed to be higher in LVC than HVC at 30 days (2.7% versus 1.6%, P < 0.001), 90 days (7.5% versus 4.0%, P < 0.001), and at 5 years (63.5% versus 59.3%, P = 0.002). Significant preoperative, independent predictors of survival include age, sex, smoking status, and the existence of certain comorbidities. Treatment at a TF or HVC were independent predictors of better outcome. Race, use of chemotherapy or radiation did not affect outcomes.<br />Conclusion: Surgical treatment for lung cancer at TF or HVC results in significantly better short- and long-term patient outcomes.
- Subjects :
- Adult
Carcinoma, Non-Small-Cell Lung mortality
Female
Florida
Humans
Lung Neoplasms mortality
Male
Middle Aged
Prognosis
Pulmonary Surgical Procedures
Quality Assurance, Health Care
Small Cell Lung Carcinoma mortality
Survival Rate
Cancer Care Facilities
Carcinoma, Non-Small-Cell Lung surgery
Hospitals, Teaching
Lung Neoplasms surgery
Outcome Assessment, Health Care
Small Cell Lung Carcinoma surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1534-4681
- Volume :
- 16
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Annals of surgical oncology
- Publication Type :
- Academic Journal
- Accession number :
- 18600379
- Full Text :
- https://doi.org/10.1245/s10434-008-0025-9