Predictors and Outcomes of Limited Resection for Early-Stage Non-Small Cell Lung Cancer

Billmeier, Sarah E.; Ayanian, John Z.; Zaslavsky, Alan M.; Nerenz, David R.; Jaklitsch, Michael T.; Rogers, Selwyn O.

doi:10.1093/jnci/djr387

Cited by 41 publications

(22 citation statements)

References 37 publications

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“…Billmeier et al 230 report a population and health system-based sample of patients with stage I or II NSCLC. Outcomes in 524 patients undergoing lobectomy were compared with those for 155 patients undergoing limited resection (120 wedge resection, 35 segmentectomy).…”

Section: Surgical Excision Biopsymentioning

confidence: 99%

British Thoracic Society guidelines for the investigation and management of pulmonary nodules: accredited by NICE

Callister

Baldwin

Akram

et al. 2015

Thorax

712

724

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Section: Surgical Excision Biopsymentioning

confidence: 99%

British Thoracic Society guidelines for the investigation and management of pulmonary nodules: accredited by NICE

Callister

Baldwin

Akram

et al. 2015

Thorax

712

724

View full text Add to dashboard Cite

“…Second, because we looked only at utilization of surgical procedures, we do not know whether insurance expansion affected other factors such as the timing or quality of surgery. 41,42 Third, our analysis did not include outpatient surgical procedures. Accordingly, we could not examine trends in the utilization of cataract surgery, cystoscopy, gastrointestinal endoscopy, and other procedures for which utilization may be particularly sensitive to changes in insurance status or supply of providers.…”

Section: Discussionmentioning

confidence: 99%

Effect of Insurance Expansion on Utilization of Inpatient Surgery

et al. 2014

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Importance While the enthusiasm for the Affordable Care Act (ACA) revolves around its impact on access to preventive and primary care services, the effect of this reform on surgical care remains undefined. Objective Using Massachusetts (MA) healthcare reform as a natural experiment, we estimate the differential impact of insurance expansion on the utilization of discretionary versus non-discretionary inpatient surgery. Design We used the State Inpatient Databases from MA and two control states to identify nonelderly patients (19–64 years) who underwent discretionary (DS) versus non-discretionary surgery (NDS) during the years 2003–2010. We defined DS as elective, preference-sensitive procedures (e.g., joint replacement, back surgery), and NDS as imperative and potentially lifesaving procedures (e.g., cancer surgery, hip fracture repair). Using July 2007 as the transition point between pre and post-reform periods, we performed a difference-in-differences (DID) analysis to estimate the effect of insurance expansion on rates of DS vs NDS among the entire study population, and for subgroups defined by race, income and insurance status. We then extrapolated our results from MA to the entire US population. Main Outcome(s) and Measure(s) Rate of DS and NDS performed before and after the healthcare reform in Massachusetts. Results We identified a total of 836,311 surgeries during the study period. In contrast to NDS, post-reform rates of DS increased more in MA than in control states. Based on our DID analysis, insurance expansion was associated with a 9.3% increase in the use of DS in MA (p=0.021). Conversely, the rate of NDS decreased by 4.5% (p=0.009). We found similar effects for DS in all subgroups, with the greatest increase observed for non-whites (19.9%, p<0.001). Based on the findings in MA, we estimated that full implementation of national insurance expansion would yield an additional 465,934 discretionary surgeries by 2017. Conclusions and Relevance Insurance expansion in Massachusetts was associated with increased rates of discretionary surgery, and a concurrent decrease in utilization of nondiscretionary surgery. If similar changes are seen nationally, the value of insurance expansion for surgical care may depend on the relative balance between increased expenditures and potential health benefits of greater access to elective inpatient procedures.

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“…Post-operative mortality for segmentectomy is 0-1%, with few exceptions [118,[125][126][127][128][129].…”

Section: Surgical Optionsmentioning

confidence: 99%

Slow-growing lung cancer as an emerging entity: from screening to clinical management

et al. 2013

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The current paradigm is that untreated lung cancer is invariably and rapidly fatal, therefore the medical community normally dismisses the idea that a patient could live with such a disease for years without any therapy.Yet evidence from lung cancer screening research and from recent clinical series suggests that, although rarely recognised in routine practice, slow-growing lung cancers do exist and are more common than previously thought.Here, current evidence is reviewed and clinical cases are illustrated to show that slow-growing lung cancer is a real clinical entity, and the reasons why management protocols developed in the screening setting may also be useful in clinical practice are discussed. Features suggesting that a lung cancer may be slow-growing are described and appraised, areas of uncertainty are examined, modern management options for earlystage disease are evaluated and the influence that all this knowledge might have on our clinical decisionmaking is weighed. Further research directed at developing appropriate guidelines for these peculiar but increasingly common patients is warranted. @ERSpublications The increasingly common incidence of slow-growing lung cancer and its influence on clinical decision-making is discussed

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Predictors and Outcomes of Limited Resection for Early-Stage Non-Small Cell Lung Cancer

Abstract: Evidence is statistically inconclusive but suggestive that lobectomy, compared with limited resection, is associated with increased long-term survival for early-stage lung cancer. Clinical, socioeconomic, and surgeon factors appear to be associated with the choice of surgical resection.

Cited by 41 publications

References 37 publications

British Thoracic Society guidelines for the investigation and management of pulmonary nodules: accredited by NICE

British Thoracic Society guidelines for the investigation and management of pulmonary nodules: accredited by NICE

Effect of Insurance Expansion on Utilization of Inpatient Surgery

Slow-growing lung cancer as an emerging entity: from screening to clinical management

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