High hospital procedure volumes linked to improved survival after lung resection

המידע באדיבות מדיקונטקסט:Last Updated: 2001-07-18 17:00:17 EDT (Reuters Health)

WESTPORT, CT (Reuters Health) – Lung cancer patients who undergo a lung resection procedure at hospitals that perform a large number of such cases are likely to survive longer than patients who undergo similar procedures at a low-volume hospital.

Dr. Peter B. Bach and colleagues, from the Memorial Sloan-Kettering Cancer Center, in New York, assessed the survival outcomes of 2118 patients, 65 years of age or older, with stage I, II, or IIIA non-small-cell lung cancer who underwent a resection procedure between 1985 and 1996 at one of 76 hospitals in the US.

Patient survival was significantly (p < 0.001) linked to the volume of procedures performed at the hospital, the authors report in The New England Journal of Medicine for July 19. The 5-year survival of patients who underwent a procedure at the highest-volume hospitals (67 to 100 cases annually) was 44% compared with 33% for patients at the lowest-volume hospitals (1 to 8 cases annually).

Patients at the highest-volume hospitals were less likely to experience postoperative complications and had a significantly lower 30-day mortality rate than patients treated at the lowest-volume hospitals, the researchers determined.

"We found a large amount of variation in the outcomes for patients who had lung cancer surgery at these different hospitals," Dr. Bach told Reuters Health. "The variation seemed to be associated with the volume of surgeries performed at each hospital," he added.

"This really is the first nationally comprehensive population-based study to investigate the relationship between hospital lung resection volume and survival," Dr. Bach noted. Other researchers have investigated this issue, but in these studies the types of lung procedures were limited or only short-term outcomes were assessed, he said.

Dr. Bach emphasized that "it is important to remember that these are aggregate numbers." He explained that "the study findings say very little about what an individual hospital's outcomes might be." It is "certainly possible that a small low-volume hospital could have outcomes that are just as good as those of the high-volume hospitals," he added.

"Volume may be a marker of quality, but I think the take-home message is that there is a lot of variation in outcomes for patients undergoing lung cancer surgery in the United States," Dr. Bach stated. "We now need to identify the reasons why these differences exist to improve the care that all patients are getting."

N Engl J Med 2001;345:181-188.

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