TY - JOUR
T1 - Contemporary Practice Patterns of Lung Volume Reduction Surgery in the United States
AU - Abdelsattar, Zaid M.
AU - Allen, Mark
AU - Blackmon, Shanda
AU - Cassivi, Stephen
AU - Mandrekar, Jay
AU - Nichols, Francis
AU - Reisenauer, Janani
AU - Wigle, Dennis
AU - Shen, K. Robert
N1 - Publisher Copyright:
© 2021 The Society of Thoracic Surgeons
PY - 2021/9
Y1 - 2021/9
N2 - Background: Contemporary data on lung volume reduction surgery (LVRS) is sparse, particularly in regard to utilization and surgical outcomes. In this context, we analyzed the practice patterns and outcomes of LVRS nationally. Methods: We identified all patients (n = 1617) undergoing LVRS at 165 hospitals between 2001 and 2017 from The Society of Thoracic Surgeons (STS) General Thoracic Database. Practice patterns were assessed at the hospital and STS regional levels. In addition, we obtained regional chronic obstructive pulmonary disease prevalence data from the Centers for Disease Control. We used hierarchical logistic regression to estimate associations with each outcome of interest and calculate risk- and reliability-adjusted outcome rates. Results: Since 2011, national LVRS utilization has been increasing with decreasing mortality rates (3.1% risk-adjusted mortality in 2016). There is wide regional variation in LVRS average caseload that is not congruent with national chronic obstructive pulmonary disease prevalence (Pearson correlation coefficient −0.11). On multivariable analysis, only older age (adjusted odds ratio 1.05, P < .001), male sex (adjusted odds ratio 1.5, P = .007), underweight body mass index (adjusted odds ratio 1.94, P = .027), and ECOG score of 4 (adjusted odds ratio 5.17, Z-score 3.91, P = .001) were associated with the occurrence of the composite outcome of major morbidity or mortality. At the hospital level, six hospitals performed 40% of all LVRS nationally with adjusted national 30-day mortality rate of 4.3% and composite outcome rate of 15.8%. Despite this, there was minimal variation in adjusted outcome rates. Conclusions: National utilization of LVRS is increasing and it has become safer overall, even at lower volume hospitals. There is regional variation in LVRS use that does not mirror national chronic obstructive pulmonary disease prevalence, suggesting access disparities. The findings have potential policy implications.
AB - Background: Contemporary data on lung volume reduction surgery (LVRS) is sparse, particularly in regard to utilization and surgical outcomes. In this context, we analyzed the practice patterns and outcomes of LVRS nationally. Methods: We identified all patients (n = 1617) undergoing LVRS at 165 hospitals between 2001 and 2017 from The Society of Thoracic Surgeons (STS) General Thoracic Database. Practice patterns were assessed at the hospital and STS regional levels. In addition, we obtained regional chronic obstructive pulmonary disease prevalence data from the Centers for Disease Control. We used hierarchical logistic regression to estimate associations with each outcome of interest and calculate risk- and reliability-adjusted outcome rates. Results: Since 2011, national LVRS utilization has been increasing with decreasing mortality rates (3.1% risk-adjusted mortality in 2016). There is wide regional variation in LVRS average caseload that is not congruent with national chronic obstructive pulmonary disease prevalence (Pearson correlation coefficient −0.11). On multivariable analysis, only older age (adjusted odds ratio 1.05, P < .001), male sex (adjusted odds ratio 1.5, P = .007), underweight body mass index (adjusted odds ratio 1.94, P = .027), and ECOG score of 4 (adjusted odds ratio 5.17, Z-score 3.91, P = .001) were associated with the occurrence of the composite outcome of major morbidity or mortality. At the hospital level, six hospitals performed 40% of all LVRS nationally with adjusted national 30-day mortality rate of 4.3% and composite outcome rate of 15.8%. Despite this, there was minimal variation in adjusted outcome rates. Conclusions: National utilization of LVRS is increasing and it has become safer overall, even at lower volume hospitals. There is regional variation in LVRS use that does not mirror national chronic obstructive pulmonary disease prevalence, suggesting access disparities. The findings have potential policy implications.
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U2 - 10.1016/j.athoracsur.2020.08.058
DO - 10.1016/j.athoracsur.2020.08.058
M3 - Article
C2 - 33161015
AN - SCOPUS:85105478212
SN - 0003-4975
VL - 112
SP - 952
EP - 960
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 3
ER -