Are minimum volume standards appropriate for lung and esophageal surgery?

Harrison, S.; Tangel, Virginia; Wu, Xian; Christos, Paul J.; Gaber-Baylis, Licia K.; Turnbull, Zachary A.; Port, J. L.; Altorki, Nasser K.; Stiles, Brendon M.

doi:10.1016/j.jtcvs.2017.11.073

Cited by 30 publications

(24 citation statements)

References 16 publications

(31 reference statements)

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“…Other studies attempted to show that volume standards were not correlated to improved surgical outcomes. Harrison and colleagues 19 used the Healthcare Cost and Utilization Project State Inpatient Database (California, Florida, and New York) to compare in-hospital mortality, major complication rates, and length of stay for patients whose hospitals did and did not meet Leapfrog volume criteria for lung (>40 resections/year) and esophageal (>20 esophagectomies/year) surgery. They performed a propensitymatched analysis of patients undergoing lobectomy/ pneumonectomy and esophagectomy.…”

Section: Is the Volume-outcomes Relationship Causal?mentioning

confidence: 99%

Regionalization for thoracic surgery: Economic implications of regionalization in the United States

Subramanian

Yang

Chang

2021

The Journal of Thoracic and Cardiovascular Surgery

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Section: Is the Volume-outcomes Relationship Causal?mentioning

confidence: 99%

Regionalization for thoracic surgery: Economic implications of regionalization in the United States

Subramanian

Yang

Chang

2021

The Journal of Thoracic and Cardiovascular Surgery

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“…Esophagectomy remains a complex surgical intervention overwhelmed by a post-operative complication rate of up to 60%, but high volume centres performing more than 20 esophagectomies annually were found to record fewer complications and exhibit better overall survival thanks to higher levels of team expertise (7,8).…”

Section: Introductionmentioning

confidence: 99%

Peri-operative approach to esophagectomy: a narrative review from the anesthesiological standpoint

Deana¹,

Vetrugno²,

Bignami³

et al. 2021

J Thorac Dis

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Objective: This review summarizes the peri-operative anesthesiological approaches to esophagectomy considering the best up-to-date, evidence-based medicine, discussed from the anesthesiologist's standpoint. Background: Esophagectomy is the only curative therapy for esophageal cancer. Despite the many advancements made in the surgical treatment of this tumour, esophagectomy still carries a morbidity rate reaching 60%. Patients undergoing esophagectomy should be referred to high volume centres where they can receive a multidisciplinary approach to treatment, associated with better outcomes. The anesthesiologist is the key figure who should guide the peri-operative phase, from diagnosis through to post-surgery rehabilitation. We performed an updated narrative review devoted to the study of anesthesia management for esophagectomy in cancer patients. Methods: We searched MEDLINE, Scopus and Google Scholar databases from inception to May 2021. We used the following terms: "esophagectomy", "esophagectomy AND pre-operative evaluation", "esophagectomy AND protective lung ventilation", "esophagectomy AND hemodynamic monitoring" and "esophagectomy AND analgesia". We considered only articles with abstract written in English and available to the reader. We excluded single case-reports. Conclusions: Pre-operative anesthesiological evaluation is mandatory in order to stratify and optimize any medical condition. During surgery, protective ventilation and judicious fluid management are the cornerstones of intraoperative "protective anesthesia". Post-operative care should be provided by an intensive care unit or high-dependency unit depending on the patient's condition, the type of surgery endured and the availability of local resources. The provision of adequate post-operative analgesia favours early mobilization and rapid recovery. Anesthesiologist has an important role during the peri-operative care for esophagectomy.However, there are still some topics that need to be further studied to improve the outcome of these patients.

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“…Studies have described a relationship between surgical volume and improved short-term outcomes in lobectomy and other surgical procedures [1,2], as well as a relationship between hospital volume and mortality in common medical conditions [3]. However, regarding surgical outcomes, subsequent research challenged these results and cast doubt on the influence of surgical volume on outcomes in lung cancer resection [4][5][6]. Studies regarding the association between hospital volume and quality of care and processes of cancer care, have resulted in improved outcomes with higher hospital volume in different types of cancer, and support centralization of care.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, research about the influence of hospital and surgical volumes in lung cancer so far mainly focused on patients with operable cancer. In these studies, the main outcomes were inhospital death and survival and only some investigated complication rates or length of stay [4,[10][11][12]. Moreover, the observation period was limited to the hospital stay of the resection in most studies [10].…”

Section: Introductionmentioning

confidence: 99%

Differences in therapy and survival between lung cancer patients treated in hospitals with high and low patient case volume

et al. 2020

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Background : In light of political discussions about minimum case volumes and certified lung cancer centers, this observational study investigates differences in therapy and survival between high vs. low patient volume hospitals (HPVH vs. LPVH). Methods :We identified 12,374 lung cancer patients treated in HPVH (>67 patients) and LPVH in 2013 from German health insurance claims. Stratified by metastasis status (no metastases, nodal metastases, systemic metastases), we compared HPVHs and LPVHs regarding likelihood of resection and systemic therapy, type of systemic therapy, and surgical outcomes, using multivariate logistic models. Three-year survival was modeled using Cox regression. We adjusted all regression models for age, gender, comorbidity, and residence area, and included a cluster variable for the hospital.Results : Around 24 % of patients were treated in HPVHs. Irrespective of stratum and subgroup, three-year survival was significantly better in HPVHs. In patients with systemic metastases (OR = 1.84, CI=[1.22,2.76]) and without metastases (OR = 3.28, CI=[2.13, 5.04]), resection was more likely in HPVHs.Among patients with systemic therapy, the odds of receiving pemetrexed was higher in HPVHs, in patients with nodal metastases (OR = 1.57, CI=[1.01,2.45]).In resected patients without metastases the odds ratio of receiving a thoracoscopic lobectomy was 2.28 (CI=[1.04,4.99]) in HPVHs. Conclusion :Our data suggests that case volume is clinically relevant in resected and non-resected lung cancer patients, but optimal minimum case volumes may differ for subgroups.

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Are minimum volume standards appropriate for lung and esophageal surgery?

Cited by 30 publications

References 16 publications

Regionalization for thoracic surgery: Economic implications of regionalization in the United States

Regionalization for thoracic surgery: Economic implications of regionalization in the United States

Peri-operative approach to esophagectomy: a narrative review from the anesthesiological standpoint

Differences in therapy and survival between lung cancer patients treated in hospitals with high and low patient case volume

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