Closing the gap: Contribution of surgical best practices to outcome differences between high‐ and low‐volume centers for lung cancer resection

Itzstein, Mitchell S. von; Lü, Rong; Kernstine, Kemp H.; Halm, Ethan A.; Wang, Shidan; Xie, Yang; Gerber, David E.

doi:10.1002/cam4.3055

Cited by 12 publications

(6 citation statements)

References 38 publications

(81 reference statements)

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“…Improved outcomes in academic settings are generally attributed to higher compliance with clinical practice guidelines, 37 use of best surgical practices, and high patient volumes. 39 However, in a comparison of clinical outcomes after NSCLC resection between small-volume and high-volume practices, von Itstein recently demonstrated that although OS was improved at high-volume centers, when controlling for best surgical practices, there was no difference between high-volume and low-volume practices. 39 Consistent with these findings, our study strongly suggests that survival outcome did not differ between patients treated at an academic medical center and those treated at a community oncology practice, when reviewed by the UK MCC-MTB.…”

Section: Discussionmentioning

confidence: 99%

Molecular Tumor Board Review and Improved Overall Survival in Non–Small-Cell Lung Cancer

Huang

Chen

Allison

et al. 2021

JCO Precision Oncology

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PURPOSE With the introduction of precision medicine, treatment options for non–small-cell lung cancer have improved dramatically; however, underutilization, especially in disadvantaged patients, like those living in rural Appalachian regions, is associated with poorer survival. Molecular tumor boards (MTBs) represent a strategy to increase precision medicine use. UK HealthCare at the University of Kentucky (UK) implemented a statewide MTB in January 2017. We wanted to test the impact of UK MTB review on overall survival in Appalachian and other regions in Kentucky. METHODS We performed a case-control study of Kentucky patients newly diagnosed with non–small-cell lung cancer between 2017 and 2019. Cases were reviewed by the UK MTB and were compared with controls without UK MTB review. Controls were identified from the Kentucky Cancer Registry and propensity-matched to cases. The primary end point was the association between MTB review and overall patient survival. RESULTS Overall, 956 patients were included, with 343 (39%) residing in an Appalachian region. Seventy-seven (8.1%) were reviewed by the MTB and classified as cases. Cox regression analysis showed that poorer survival outcome was associated with lack of MTB review (hazard ratio [HR] = 8.61; 95% CI, 3.83 to 19.31; P < .0001) and living in an Appalachian region (hazard ratio = 1.43; 95% CI, 1.17 to 1.75; P = .004). Among individuals with MTB review, survival outcomes were similar regardless of whether they lived in Appalachia or other parts of Kentucky. CONCLUSION MTB review is an independent positive predictor of overall survival regardless of residence location. MTBs may help overcome some health disparities for disadvantaged populations.

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Section: Discussionmentioning

confidence: 99%

Molecular Tumor Board Review and Improved Overall Survival in Non–Small-Cell Lung Cancer

Huang

Chen

Allison

et al. 2021

JCO Precision Oncology

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“…Elucidating the influence of facility volume on short‐ or long‐term patient outcomes (i.e., volume–outcomes relationship) is an important endeavor that can lead to better delivery of quality care and more centralized cancer treatment in the future 14,15 . Although recent studies have demonstrated improved survival with increasing hospital volume in a variety of cancers including lung cancer, 16 Hodgkin lymphoma, 17 Merkel cell carcinoma, 18 meningioma, 19 and malignant bone tumors, 20 a thorough investigation regarding NPC is needed. Herein, this study investigates a large US‐based patient population from the National Cancer Database (NCDB) to elucidate the facility‐volume–outcomes relationships in patients with NPC.…”

Section: Introductionmentioning

confidence: 99%

The influence of facility volume on patient treatments and survival outcomes in nasopharyngeal carcinoma

et al. 2021

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Background This study evaluates the influence of facility case‐volume on nasopharyngeal carcinoma (NPC) treatments and overall survival (OS). Methods The 2004–2015 National Cancer Database was queried for patients with NPC receiving definitive treatment. Results A total of 8260 patients (5‐year OS: 63.4%) were included. The 1114 unique facilities were categorized into 854 low‐volume (treating 1–8 patients), 200 intermediate‐volume (treating 9–23 patients), and 60 high‐volume (treating 24–187 patients) facilities. Kaplan–Meier log‐rank analysis demonstrated significantly improved OS with high‐volume facilities (p < 0.001). On cox proportional‐hazard multivariate regression after adjusting for age, sex, income, insurance, comorbidity index, histology, AJCC clinical stage, and treatment type, high‐volume facilities were associated with lower mortality risk than low‐volume (HR = 0.865, p = 0.019) and intermediate‐volume facilities (HR = 0.916, p = 0.004). Propensity score matching analysis confirmed this association (p < 0.001). Conclusion Higher facility volume was an independent predictor of improved OS in NPC, suggesting a possible survival benefit of referrals to high‐volume medical centers.

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“…In this study, a higher case volume hospital was associated with a lower prevalence of both postoperative fatal respiratory events and in-hospital mortality. For postoperative patient management, it is more likely that high case volume hospitals with a large number of specialized medical staff and better 24-hour care enable the prevention of fatal respiratory events through faster and adequate diagnosis and intervention (22,24). Wang et al reported that pulmonary complications after lung resection were associated with prolonged LOS and increased hospitalization costs (25).…”

Section: Discussionmentioning

confidence: 99%

“…This result may be related to the higher prevalence of postoperative fatal respiratory events in the low case volume center, as shown in Table 2 . However, a previous study reported that the impact of hospital case volume on clinical outcomes was not fixed and might be improved by education, systematic, and faculty improvement ( 22 ). In a previous study conducted in Taiwan, hospital case volume alone was not a significant predictor of in-hospital mortality following lung cancer surgery after adjusting for patient, surgeon, and hospital characteristics ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

Risks and outcome of fatal respiratory events after lung cancer surgery: cohort study in South Korea

Oh¹,

Song²,

Hwang³

et al. 2023

J Thorac Dis

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Background: Severe complications such as acute respiratory distress syndrome or respiratory failure can occur after lung cancer surgery. However, the prevalence and risk factors have not been well identified. The aim of this study was to investigate the prevalence of and risk factors for fatal respiratory events after lung cancer surgery in South Korea. Methods:The National Health Insurance Service database in South Korea was used to extract data of all adult patients who were diagnosed with lung cancer and underwent lung cancer surgery from January 1, 2011, to December 31, 2018, for a population-based cohort study. Diagnosis of acute respiratory distress syndrome or respiratory failure after surgery was defined as postoperative fatal respiratory event.Results: A total of 60,031 adult patients who received lung cancer surgery were included in the analysis.Among them, 0.5% (285/60,031) experienced fatal respiratory events after the lung cancer surgery. In multivariable logistic regression, some risk factors (older age, male sex, higher Charlson comorbidity index score, underlying severe disability, bilobectomy, pneumonectomy, redo-case, lower case volume, and open thoracotomy) for developing postoperative fatal respiratory events were identified. Moreover, the development of postoperative fatal respiratory events was associated with high in-hospital mortality, 1-year mortality, longer length of hospital stays, and higher total hospitalization costs.Conclusions: Postoperative fatal respiratory events might worsen the clinical outcomes of lung cancer surgery. The knowledge of potential risk factors related to postoperative fatal respiratory events could enable earlier intervention to reduce the occurrence of these events and improve the postoperative clinical outcome.

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Closing the gap: Contribution of surgical best practices to outcome differences between high‐ and low‐volume centers for lung cancer resection

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 12 publications

References 38 publications

Molecular Tumor Board Review and Improved Overall Survival in Non–Small-Cell Lung Cancer

Molecular Tumor Board Review and Improved Overall Survival in Non–Small-Cell Lung Cancer

The influence of facility volume on patient treatments and survival outcomes in nasopharyngeal carcinoma

Risks and outcome of fatal respiratory events after lung cancer surgery: cohort study in South Korea

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