Variation in Hospital Adoption Rates of Video-Assisted Thoracoscopic Lobectomy for Lung Cancer and the Effect on Outcomes

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

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background This study examined the variation in the adoption of video-assisted thoracoscopic surgery (VATS) for lobectomy across United States hospitals from a population-based national database. Methods We used the National Cancer Data Base to identify patients undergoing lobectomy between 2010 and 2012 and used hierarchical regression to estimate case-mix–adjusted VATS lobectomy rates using patient and tumor characteristics. We stratified hospitals into quintiles by adjusted VATS lobectomy rates. To account for lack of equipment to perform minimally invasive thoracoscopic operations, we also obtained data on VATS wedge resections. Results Of 55,972 cancer lobectomies performed at 905 hospitals, 17,072 (30.5%) were VATS. Crude hospital VATS use varied widely (mean was 25.5% of all lobectomies per hospital; interquartile range, 4.4% to 42.3%). Variation persisted after case-mix adjustment. For example, VATS rates at the highest and lowest quintiles were 76% vs 0.6%, respectively. Differences in patient and tumor characteristics across quintiles were negligible, and there was no indication that those hospitals lacked VATS equipment. The risk-adjusted same-hospital readmission (6.7% vs 7%; p > 0.2), 30-day mortality (1.5% vs 1.5%; p > 0.2), and 90-day mortality (2.9% vs 2.7%; p = 0.038) rates were similar between the highest and lowest quintiles. Length of stay was shorter at hospitals in the highest VATS quintile (6.6 vs 7.4 days; p < 0.001). Conclusions Adoption of VATS lobectomy varies widely across United States hospitals. This variation cannot be explained by patient or tumor characteristics or by a shortage of VATS equipment. Efforts to reduce this variation will require the dissemination and implementation of novel training techniques and learning opportunities for surgeons.

Original languageEnglish (US)
Pages (from-to)454-460
Number of pages7
JournalAnnals of Thoracic Surgery
Volume103
Issue number2
DOIs
StatePublished - Feb 1 2017

Fingerprint

Video-Assisted Thoracic Surgery
Lung Neoplasms
State Hospitals
Neoplasms
Equipment and Supplies
Databases
Risk Adjustment
Mortality
Length of Stay
Teaching
Learning

ASJC Scopus subject areas

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

Cite this

Variation in Hospital Adoption Rates of Video-Assisted Thoracoscopic Lobectomy for Lung Cancer and the Effect on Outcomes. / Abdelsattar, Zaid M.; Allen, Mark S.; Shen, K. Robert; Cassivi, Stephen D.; Nichols, Francis C.; Wigle, Dennis A; Blackmon, Shanda H.

In: Annals of Thoracic Surgery, Vol. 103, No. 2, 01.02.2017, p. 454-460.

Research output: Contribution to journalArticle

Abdelsattar, Zaid M. ; Allen, Mark S. ; Shen, K. Robert ; Cassivi, Stephen D. ; Nichols, Francis C. ; Wigle, Dennis A ; Blackmon, Shanda H. / Variation in Hospital Adoption Rates of Video-Assisted Thoracoscopic Lobectomy for Lung Cancer and the Effect on Outcomes. In: Annals of Thoracic Surgery. 2017 ; Vol. 103, No. 2. pp. 454-460.
@article{9ca244987f9544d0b88b685f98992f4b,
title = "Variation in Hospital Adoption Rates of Video-Assisted Thoracoscopic Lobectomy for Lung Cancer and the Effect on Outcomes",
abstract = "Background This study examined the variation in the adoption of video-assisted thoracoscopic surgery (VATS) for lobectomy across United States hospitals from a population-based national database. Methods We used the National Cancer Data Base to identify patients undergoing lobectomy between 2010 and 2012 and used hierarchical regression to estimate case-mix–adjusted VATS lobectomy rates using patient and tumor characteristics. We stratified hospitals into quintiles by adjusted VATS lobectomy rates. To account for lack of equipment to perform minimally invasive thoracoscopic operations, we also obtained data on VATS wedge resections. Results Of 55,972 cancer lobectomies performed at 905 hospitals, 17,072 (30.5{\%}) were VATS. Crude hospital VATS use varied widely (mean was 25.5{\%} of all lobectomies per hospital; interquartile range, 4.4{\%} to 42.3{\%}). Variation persisted after case-mix adjustment. For example, VATS rates at the highest and lowest quintiles were 76{\%} vs 0.6{\%}, respectively. Differences in patient and tumor characteristics across quintiles were negligible, and there was no indication that those hospitals lacked VATS equipment. The risk-adjusted same-hospital readmission (6.7{\%} vs 7{\%}; p > 0.2), 30-day mortality (1.5{\%} vs 1.5{\%}; p > 0.2), and 90-day mortality (2.9{\%} vs 2.7{\%}; p = 0.038) rates were similar between the highest and lowest quintiles. Length of stay was shorter at hospitals in the highest VATS quintile (6.6 vs 7.4 days; p < 0.001). Conclusions Adoption of VATS lobectomy varies widely across United States hospitals. This variation cannot be explained by patient or tumor characteristics or by a shortage of VATS equipment. Efforts to reduce this variation will require the dissemination and implementation of novel training techniques and learning opportunities for surgeons.",
author = "Abdelsattar, {Zaid M.} and Allen, {Mark S.} and Shen, {K. Robert} and Cassivi, {Stephen D.} and Nichols, {Francis C.} and Wigle, {Dennis A} and Blackmon, {Shanda H.}",
year = "2017",
month = "2",
day = "1",
doi = "10.1016/j.athoracsur.2016.08.091",
language = "English (US)",
volume = "103",
pages = "454--460",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "2",

}

TY - JOUR

T1 - Variation in Hospital Adoption Rates of Video-Assisted Thoracoscopic Lobectomy for Lung Cancer and the Effect on Outcomes

AU - Abdelsattar, Zaid M.

AU - Allen, Mark S.

AU - Shen, K. Robert

AU - Cassivi, Stephen D.

AU - Nichols, Francis C.

AU - Wigle, Dennis A

AU - Blackmon, Shanda H.

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Background This study examined the variation in the adoption of video-assisted thoracoscopic surgery (VATS) for lobectomy across United States hospitals from a population-based national database. Methods We used the National Cancer Data Base to identify patients undergoing lobectomy between 2010 and 2012 and used hierarchical regression to estimate case-mix–adjusted VATS lobectomy rates using patient and tumor characteristics. We stratified hospitals into quintiles by adjusted VATS lobectomy rates. To account for lack of equipment to perform minimally invasive thoracoscopic operations, we also obtained data on VATS wedge resections. Results Of 55,972 cancer lobectomies performed at 905 hospitals, 17,072 (30.5%) were VATS. Crude hospital VATS use varied widely (mean was 25.5% of all lobectomies per hospital; interquartile range, 4.4% to 42.3%). Variation persisted after case-mix adjustment. For example, VATS rates at the highest and lowest quintiles were 76% vs 0.6%, respectively. Differences in patient and tumor characteristics across quintiles were negligible, and there was no indication that those hospitals lacked VATS equipment. The risk-adjusted same-hospital readmission (6.7% vs 7%; p > 0.2), 30-day mortality (1.5% vs 1.5%; p > 0.2), and 90-day mortality (2.9% vs 2.7%; p = 0.038) rates were similar between the highest and lowest quintiles. Length of stay was shorter at hospitals in the highest VATS quintile (6.6 vs 7.4 days; p < 0.001). Conclusions Adoption of VATS lobectomy varies widely across United States hospitals. This variation cannot be explained by patient or tumor characteristics or by a shortage of VATS equipment. Efforts to reduce this variation will require the dissemination and implementation of novel training techniques and learning opportunities for surgeons.

AB - Background This study examined the variation in the adoption of video-assisted thoracoscopic surgery (VATS) for lobectomy across United States hospitals from a population-based national database. Methods We used the National Cancer Data Base to identify patients undergoing lobectomy between 2010 and 2012 and used hierarchical regression to estimate case-mix–adjusted VATS lobectomy rates using patient and tumor characteristics. We stratified hospitals into quintiles by adjusted VATS lobectomy rates. To account for lack of equipment to perform minimally invasive thoracoscopic operations, we also obtained data on VATS wedge resections. Results Of 55,972 cancer lobectomies performed at 905 hospitals, 17,072 (30.5%) were VATS. Crude hospital VATS use varied widely (mean was 25.5% of all lobectomies per hospital; interquartile range, 4.4% to 42.3%). Variation persisted after case-mix adjustment. For example, VATS rates at the highest and lowest quintiles were 76% vs 0.6%, respectively. Differences in patient and tumor characteristics across quintiles were negligible, and there was no indication that those hospitals lacked VATS equipment. The risk-adjusted same-hospital readmission (6.7% vs 7%; p > 0.2), 30-day mortality (1.5% vs 1.5%; p > 0.2), and 90-day mortality (2.9% vs 2.7%; p = 0.038) rates were similar between the highest and lowest quintiles. Length of stay was shorter at hospitals in the highest VATS quintile (6.6 vs 7.4 days; p < 0.001). Conclusions Adoption of VATS lobectomy varies widely across United States hospitals. This variation cannot be explained by patient or tumor characteristics or by a shortage of VATS equipment. Efforts to reduce this variation will require the dissemination and implementation of novel training techniques and learning opportunities for surgeons.

UR - http://www.scopus.com/inward/record.url?scp=85006141204&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85006141204&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2016.08.091

DO - 10.1016/j.athoracsur.2016.08.091

M3 - Article

C2 - 27825690

AN - SCOPUS:85006141204

VL - 103

SP - 454

EP - 460

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 2

ER -