Outcomes After Sleeve Lung Resections Versus Pneumonectomy in the United States

Zaid M. Abdelsattar, K. Robert Shen, Sai Yendamuri, Stephen Cassivi, Francis C. Nichols, Dennis A Wigle, Mark S. Allen, Shanda H. Blackmon

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background: The current national trends, practice patterns, and outcomes after sleeve resection compared with pneumonectomy in the United States are not known. In addition, whether hospital sleeve-to-pneumonectomy (S:P) ratios are a valid marker of hospital quality is unclear. We describe practice patterns and evaluate the utility of the S:P ratio. Methods: We identified all patients (N = 23,964) undergoing sleeve resection (n = 1,713) or pneumonectomy (n = 22,251) in the National Cancer Data Base between 1998 and 2012 at 644 hospitals. We used propensity score matching to compare short-term outcomes and overall survival between pneumonectomy and sleeve resection. We grouped hospitals into S:P ratio quintiles and used multilevel modeling to analyze hospital-level outcomes. Results: There has been a 1% yearly increase in sleeve resection rates, with wide variation in hospital S:P ratios (middle quintile, 1:12; range, 1:38 to 1:3). After propensity score matching, differences in age, clinical T and N stage, and the incidence of main bronchus tumors were negligible among other variables. Sleeve resections were associated with lower 30-day (1.6% vs 5.9%; p < 0.001) and 90-day mortality (4% vs 9.4%; p < 0.001) and improved overall survival. Hospitals with higher S:P ratios were not associated with better risk-adjusted 30-day (7.2% vs 7.4%; p = 0.244) or 90-day mortality (11.9% vs 12.2%; p = 0.308) or same-hospital readmission rates (3.7% vs 4.3%; p = 0.523). Conclusions: Compared with pneumonectomy, sleeve resections are associated with improved short-term outcomes and improved overall survival. However, hospital S:P ratios were not associated with better risk-adjusted outcomes and thus may not be a valid quality measure.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
DOIs
StateAccepted/In press - 2017

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Pneumonectomy
Lung
Propensity Score
Survival
Patient Readmission
Mortality
Bronchi
Neoplasms
Databases

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Abdelsattar, Z. M., Shen, K. R., Yendamuri, S., Cassivi, S., Nichols, F. C., Wigle, D. A., ... Blackmon, S. H. (Accepted/In press). Outcomes After Sleeve Lung Resections Versus Pneumonectomy in the United States. Annals of Thoracic Surgery. https://doi.org/10.1016/j.athoracsur.2017.05.086

Outcomes After Sleeve Lung Resections Versus Pneumonectomy in the United States. / Abdelsattar, Zaid M.; Shen, K. Robert; Yendamuri, Sai; Cassivi, Stephen; Nichols, Francis C.; Wigle, Dennis A; Allen, Mark S.; Blackmon, Shanda H.

In: Annals of Thoracic Surgery, 2017.

Research output: Contribution to journalArticle

Abdelsattar, Zaid M. ; Shen, K. Robert ; Yendamuri, Sai ; Cassivi, Stephen ; Nichols, Francis C. ; Wigle, Dennis A ; Allen, Mark S. ; Blackmon, Shanda H. / Outcomes After Sleeve Lung Resections Versus Pneumonectomy in the United States. In: Annals of Thoracic Surgery. 2017.
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T1 - Outcomes After Sleeve Lung Resections Versus Pneumonectomy in the United States

AU - Abdelsattar, Zaid M.

AU - Shen, K. Robert

AU - Yendamuri, Sai

AU - Cassivi, Stephen

AU - Nichols, Francis C.

AU - Wigle, Dennis A

AU - Allen, Mark S.

AU - Blackmon, Shanda H.

PY - 2017

Y1 - 2017

N2 - Background: The current national trends, practice patterns, and outcomes after sleeve resection compared with pneumonectomy in the United States are not known. In addition, whether hospital sleeve-to-pneumonectomy (S:P) ratios are a valid marker of hospital quality is unclear. We describe practice patterns and evaluate the utility of the S:P ratio. Methods: We identified all patients (N = 23,964) undergoing sleeve resection (n = 1,713) or pneumonectomy (n = 22,251) in the National Cancer Data Base between 1998 and 2012 at 644 hospitals. We used propensity score matching to compare short-term outcomes and overall survival between pneumonectomy and sleeve resection. We grouped hospitals into S:P ratio quintiles and used multilevel modeling to analyze hospital-level outcomes. Results: There has been a 1% yearly increase in sleeve resection rates, with wide variation in hospital S:P ratios (middle quintile, 1:12; range, 1:38 to 1:3). After propensity score matching, differences in age, clinical T and N stage, and the incidence of main bronchus tumors were negligible among other variables. Sleeve resections were associated with lower 30-day (1.6% vs 5.9%; p < 0.001) and 90-day mortality (4% vs 9.4%; p < 0.001) and improved overall survival. Hospitals with higher S:P ratios were not associated with better risk-adjusted 30-day (7.2% vs 7.4%; p = 0.244) or 90-day mortality (11.9% vs 12.2%; p = 0.308) or same-hospital readmission rates (3.7% vs 4.3%; p = 0.523). Conclusions: Compared with pneumonectomy, sleeve resections are associated with improved short-term outcomes and improved overall survival. However, hospital S:P ratios were not associated with better risk-adjusted outcomes and thus may not be a valid quality measure.

AB - Background: The current national trends, practice patterns, and outcomes after sleeve resection compared with pneumonectomy in the United States are not known. In addition, whether hospital sleeve-to-pneumonectomy (S:P) ratios are a valid marker of hospital quality is unclear. We describe practice patterns and evaluate the utility of the S:P ratio. Methods: We identified all patients (N = 23,964) undergoing sleeve resection (n = 1,713) or pneumonectomy (n = 22,251) in the National Cancer Data Base between 1998 and 2012 at 644 hospitals. We used propensity score matching to compare short-term outcomes and overall survival between pneumonectomy and sleeve resection. We grouped hospitals into S:P ratio quintiles and used multilevel modeling to analyze hospital-level outcomes. Results: There has been a 1% yearly increase in sleeve resection rates, with wide variation in hospital S:P ratios (middle quintile, 1:12; range, 1:38 to 1:3). After propensity score matching, differences in age, clinical T and N stage, and the incidence of main bronchus tumors were negligible among other variables. Sleeve resections were associated with lower 30-day (1.6% vs 5.9%; p < 0.001) and 90-day mortality (4% vs 9.4%; p < 0.001) and improved overall survival. Hospitals with higher S:P ratios were not associated with better risk-adjusted 30-day (7.2% vs 7.4%; p = 0.244) or 90-day mortality (11.9% vs 12.2%; p = 0.308) or same-hospital readmission rates (3.7% vs 4.3%; p = 0.523). Conclusions: Compared with pneumonectomy, sleeve resections are associated with improved short-term outcomes and improved overall survival. However, hospital S:P ratios were not associated with better risk-adjusted outcomes and thus may not be a valid quality measure.

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