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Clinical and financial outcomes of pulmonary resection for lung cancer in safety-net hospitals.

Clinical and financial outcomes of pulmonary resection for lung cancer in safety-net hospitals.

Authors :
Sakowitz, Sara
Verma, Arjun
Mabeza, Russyan Mark
Cho, Nam Yong
Hadaya, Joseph
Toste, Paul
Benharash, Peyman
Source :
Journal of Thoracic & Cardiovascular Surgery; Apr2023, Vol. 165 Issue 4, p1577-1577, 1p
Publication Year :
2023

Abstract

Safety-net hospitals (SNHs) have previously been associated with inferior outcomes and greater resource use. However, this relationship has not been explored in the contemporary setting of pulmonary lobectomy. In the present national study we characterized the association between SNHs and mortality, complications, and resource use. All adults (18 years of age or older) who underwent elective lobectomy for lung cancer were identified within the 2010 to 2019 Nationwide Readmissions Database. Hospitals in the highest quartile of safety-net burden were categorized as SNHs, and others non-SNHs. Multivariable regressions were developed to assess the independent association between safety-net status and outcomes of interest. Of an estimated 282,011 patients who met inclusion criteria, 41,015 (14.5%) were treated at SNHs. Patients at SNHs were younger but as commonly female, compared with non-SNHs. After multivariable adjustment, there was no association between SNHs and mortality. However, treatment at SNHs was linked to higher odds of pneumonia (adjusted odds ratio [AOR], 1.11; 95% CI, 1.02-1.21) and prolonged ventilation (AOR, 1.36; 95% CI, 1.11-1.66), as well as infectious (AOR, 1.24; 95% CI, 1.08-1.43), intraoperative (AOR, 1.22; 95% CI, 1.07-1.39), and overall complications (AOR, 1.07; 95% CI, 1.01-1.14). Patients at SNHs also showed a greater need for a blood transfusion (AOR, 1.37; 95% CI, 1.23-1.53). In addition, SNHs were associated with increased length of stay (+0.33 days; 95% CI, 0.17-0.48) and greater costs (+$4130; 95% CI, 3.34-4.92), relative to non-SNHs. Hospital safety-net status was associated with greater odds of perioperative complications and greater health care expenditure. Further investigation is necessary uncover the mechanisms contributing to these complications and eradicate persistent disparities in lobectomy. [Display omitted] [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
00225223
Volume :
165
Issue :
4
Database :
Supplemental Index
Journal :
Journal of Thoracic & Cardiovascular Surgery
Publication Type :
Academic Journal
Accession number :
162384425
Full Text :
https://doi.org/10.1016/j.jtcvs.2022.09.036