Major lung resection safest at high-volume hospitals

Major lung surgery has become progressively safer over the last few decades, although higher death rates at low-volume hospitals and an unexpected increase in mortality at 90 days compared to 30 days were observed in a major new study. This study used data from the National Cancer Data Base (NCDB) to detail the impact of annual hospital volume on 30- and 90-day mortality rates.

The study further suggests that choosing a center that performs major lung surgery regularly can have a strong impact on survival. These findings were presented at the 94th American Association for Thoracic Surgery Annual Meeting, in Toronto, Ontario, Canada.

Lung cancer is the leading cause of death from cancer in both men and women in the United States. The best chance to cure lung cancer after it develops involves a combination of early detection at an operable stage, followed by surgery to remove the portion of the lung where the cancer developed. The number of operations for lung cancer is likely to increase with lung cancer screening.

The study used the NCDB cancer treatment and outcomes database, which is a joint project co-sponsored by the American Cancer Society and the American College of Surgeons. The NCDB captures more than 80% of all new lung cancer cases treated in the United States each year.

Data was evaluated for 121,099 patients who underwent major pulmonary resection for lung cancer at more than 1,200 Commission on Cancer-accredited hospitals across the United States between 2007 and 2011. Survival at 30 days and 90 days after surgery and numerous risk factors for dying after the surgery were evaluated.

Analysis revealed that at all 1,200+ hospitals combined, 2.8% of patients who underwent major lung surgery (93% of which were lobectomies or bi-lobectomies) died within 30 days after their surgery during this 5-year period. This rate was lower than reported from the busiest hospitals with the highest volume of surgeries just a decade ago.

Further analysis showed that annual hospital volume of major lung operations for cancer had a significant impact on both 30-day and 90-day mortality rates. The chance of death was twice as high at hospitals where less than 10 major lung cancer resections per year were performed (3.7%), compared to mortality at the busiest hospitals performing more than 90 such operations per year (1.7%). More than 10,000 of these operations took place at these lowest volume hospitals.

The researchers were surprised that the number of deaths by 90 days after surgery climbed to 5.4% overall, nearly double the rate at 30 days.

"This increase in the number of deaths between 30 days and 90 days after surgery was not expected and has not been extensively reported in the past, as mortality rates after surgery are traditionally examined at 30 days. The reasons for this ongoing mortality beyond 30 days are not yet clear, but deserve further investigation," says lead author Christopher M. Pezzi, MD, Department of Surgery, Abington Health, Abington Pennsylvania. Ongoing deaths between 30 days and 90 days after surgery occurred at both low- and high-volume hospitals; however, they were still less likely to occur at the busiest hospitals.

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