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Aigner C. Long segment stenosis-the narrow path to centralization in airway surgery. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae004. [PMID: 38216537 PMCID: PMC10858342 DOI: 10.1093/icvts/ivae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/09/2024] [Indexed: 01/14/2024]
Affiliation(s)
- Clemens Aigner
- Department of Thoracic Surgery, Comprehensive Center for Chest Disease, Medical University of Vienna—Vienna University Hospital, Vienna, Austria
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2
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Blum TG, Morgan RL, Durieux V, Chorostowska-Wynimko J, Baldwin DR, Boyd J, Faivre-Finn C, Galateau-Salle F, Gamarra F, Grigoriu B, Hardavella G, Hauptmann M, Jakobsen E, Jovanovic D, Knaut P, Massard G, McPhelim J, Meert AP, Milroy R, Muhr R, Mutti L, Paesmans M, Powell P, Putora PM, Rawlinson J, Rich AL, Rigau D, de Ruysscher D, Sculier JP, Schepereel A, Subotic D, Van Schil P, Tonia T, Williams C, Berghmans T. European Respiratory Society guideline on various aspects of quality in lung cancer care. Eur Respir J 2023; 61:13993003.03201-2021. [PMID: 36396145 DOI: 10.1183/13993003.03201-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/23/2022] [Indexed: 11/18/2022]
Abstract
This European Respiratory Society guideline is dedicated to the provision of good quality recommendations in lung cancer care. All the clinical recommendations contained were based on a comprehensive systematic review and evidence syntheses based on eight PICO (Patients, Intervention, Comparison, Outcomes) questions. The evidence was appraised in compliance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Evidence profiles and the GRADE Evidence to Decision frameworks were used to summarise results and to make the decision-making process transparent. A multidisciplinary Task Force panel of lung cancer experts formulated and consented the clinical recommendations following thorough discussions of the systematic review results. In particular, we have made recommendations relating to the following quality improvement measures deemed applicable to routine lung cancer care: 1) avoidance of delay in the diagnostic and therapeutic period, 2) integration of multidisciplinary teams and multidisciplinary consultations, 3) implementation of and adherence to lung cancer guidelines, 4) benefit of higher institutional/individual volume and advanced specialisation in lung cancer surgery and other procedures, 5) need for pathological confirmation of lesions in patients with pulmonary lesions and suspected lung cancer, and histological subtyping and molecular characterisation for actionable targets or response to treatment of confirmed lung cancers, 6) added value of early integration of palliative care teams or specialists, 7) advantage of integrating specific quality improvement measures, and 8) benefit of using patient decision tools. These recommendations should be reconsidered and updated, as appropriate, as new evidence becomes available.
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Affiliation(s)
- Torsten Gerriet Blum
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Valérie Durieux
- Bibliothèque des Sciences de la Santé, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Joanna Chorostowska-Wynimko
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - David R Baldwin
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | | | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | | | | | - Bogdan Grigoriu
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Georgia Hardavella
- Department of Respiratory Medicine, King's College Hospital London, London, UK
- Department of Respiratory Medicine and Allergy, King's College London, London, UK
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Neuruppin, Germany
| | - Erik Jakobsen
- Department of Thoracic Surgery, Odense University Hospital, Odense, Denmark
| | | | - Paul Knaut
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Gilbert Massard
- Faculty of Science, Technology and Medicine, University of Luxembourg and Department of Thoracic Surgery, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - John McPhelim
- Lung Cancer Nurse Specialist, Hairmyres Hospital, NHS Lanarkshire, East Kilbride, UK
| | - Anne-Pascale Meert
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Robert Milroy
- Scottish Lung Cancer Forum, Glasgow Royal Infirmary, Glasgow, UK
| | - Riccardo Muhr
- Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Luciano Mutti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
- SHRO/Temple University, Philadelphia, PA, USA
| | - Marianne Paesmans
- Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Paul Martin Putora
- Departments of Radiation Oncology, Kantonsspital St Gallen, St Gallen and University of Bern, Bern, Switzerland
| | | | - Anna L Rich
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - David Rigau
- Iberoamerican Cochrane Center, Barcelona, Spain
| | - Dirk de Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
- Erasmus Medical Center, Department of Radiation Oncology, Rotterdam, The Netherlands
| | - Jean-Paul Sculier
- Intensive Care and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Arnaud Schepereel
- Pulmonary and Thoracic Oncology, Université de Lille, Inserm, CHU Lille, Lille, France
| | - Dragan Subotic
- Clinic for Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Thierry Berghmans
- Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Brussels, Belgium
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3
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Rim Kim B, Young Sohn J, Jin Jang E, Jo J, Lee H, Geol Ryu H. Hospital case-volume and mortality after lung cancer surgery: a population-based retrospective cohort study. Lung Cancer 2022; 169:61-66. [DOI: 10.1016/j.lungcan.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 05/16/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022]
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Itamoto K, Kumamaru H, Aikou S, Yagi K, Yamashita H, Nomura S, Miyata H, Kuroda S, Fujiwara T, Endo S, Kitagawa Y, Kakeji Y, Seto Y. No association between hospital volume and short-term outcomes of some common surgeries: a retrospective cohort study based on a Japanese nationwide database. Surg Today 2022; 52:941-952. [DOI: 10.1007/s00595-022-02467-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/10/2021] [Indexed: 10/19/2022]
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Pollock C, Soder S, Ezer N, Ferraro P, Lafontaine E, Martin J, Nasir B, Liberman M. Impact of Volume on Mortality and Hospital Stay After Lung Cancer Surgery in a Single-Payer System. Ann Thorac Surg 2021; 114:1834-1841. [PMID: 34736929 DOI: 10.1016/j.athoracsur.2021.09.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 09/12/2021] [Accepted: 09/23/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is a literature gap for hospitals in single-payer healthcare systems quantifying the influence of hospital volume on outcomes following major lung cancer resection. We aimed to determine the effect of hospital volume on mortality, and length of stay (LOS). METHODS A retrospective cohort study using administrative, population-based data from a single-payer universal healthcare system was performed in adults with non-small cell lung cancer who underwent lobectomy or pneumonectomy between 2008 and 2017. Hospital volume was defined as the average annual number of major lung resections performed at each institution. Length of stay and post-operative mortality was compared using multivariable linear and non-linear regression between hospital volume categories and continuously. Adjusted association between hospital volume and post-operative mortality was determined by multivariable logistic regression. RESULTS 10,831 lung resections were performed: 1237 pneumonectomies; 9594 lobectomies. Patients undergoing lobectomy at high-volume hospitals had shorter median LOS (6 vs 8 days, p = 0.001) compared with low-volume hospitals. After adjusting for confounders, surgery at a high-volume center was significantly associated with shorter LOS after lobectomy and overall resections (p=<0.001), but not after pneumonectomy (p=0.787). Surgery at a high-volume center was positively associated with improved 90-day mortality in lobectomy and overall procedures (OR 0.607; [0.399-0.925]; and 0.632 [0.441-0.904], respectively). Volume was not a predictor of 90-day mortality after pneumonectomy (OR 0.533 [0.257-1.104], p=0.090). CONCLUSIONS Surgery at a high-volume center was positively correlated with improved 90-day survival and shorter hospital LOS. The results support regionalized lung cancer care in a single-payer healthcare system.
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Affiliation(s)
- Clare Pollock
- Division of Thoracic Surgery, Department of Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center, University of Montreal, Montreal, Quebec, Canada
| | - Stephan Soder
- Division of Thoracic Surgery, Department of Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center, University of Montreal, Montreal, Quebec, Canada
| | - Nicole Ezer
- Division of Respirology, Department of Medicine, McGill University Health Center, Center for Outcomes Research and Evaluation, Research Institute, Montreal, Quebec, Canada
| | - Pasquale Ferraro
- Division of Thoracic Surgery, Department of Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center, University of Montreal, Montreal, Quebec, Canada
| | - Edwin Lafontaine
- Division of Thoracic Surgery, Department of Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center, University of Montreal, Montreal, Quebec, Canada
| | - Jocelyne Martin
- Division of Thoracic Surgery, Department of Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center, University of Montreal, Montreal, Quebec, Canada
| | - Basil Nasir
- Division of Thoracic Surgery, Department of Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center, University of Montreal, Montreal, Quebec, Canada
| | - Moishe Liberman
- Division of Thoracic Surgery, Department of Surgery, CHUM Endoscopic Tracheobronchial and Oesophageal Center, University of Montreal, Montreal, Quebec, Canada.
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Stenger M, Jakobsen E, Wright G, Zalcberg J, Stirling RG. A comparison of outcomes and survival between Victoria and Denmark in lung cancer surgery: opportunities for international benchmarking. ANZ J Surg 2021; 92:1050-1055. [PMID: 34676962 DOI: 10.1111/ans.17302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/25/2021] [Accepted: 09/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUNDS Victoria (Australia) and Denmark have comparable population sizes and high-quality healthcare systems. Lung cancer surgery, however, is performed in more than 20 Victorian hospitals compared to four in Denmark. Such differences in centralization may influence outcomes. We engaged clinical quality registries to enable international benchmarking by exploring patterns of lung cancer surgery including mortality and survival. METHODS All patients undergoing lung cancer surgery between 2015 and 2018 registered in the Victorian Lung Cancer Registry and the Danish Lung Cancer Registry were included. Analyses on stage concordance, 30 and 90-day mortality, and overall survival were restricted to a selected subgroup with NSCLC and no neo-adjuvant therapy or metastatic disease and only one operation. RESULTS We included 1554 Victorian and 4319 Danish patients. The resection rate was 26.3% in Victoria and 28% in Denmark, but a higher proportion of Victorian patients underwent wedge resection (19.1% versus 8.8%). Stage concordance was 59.6% and 54.9% in Victoria and Denmark, respectively. The 30- and 90-day mortality was 1.3% and 2.6% in Victoria, compared to 1.4% and 2.8% in Denmark with no difference in overall survival (p = 0.28) or risk-adjusted survival (HR: 1.10 (95% CI: 0.89-1.37); p = 0.38). CONCLUSION High-quality surgical lung cancer care was confirmed by similar high resection and low mortality rates including no overall survival difference. The drivers and consequences of stage discordance and differences in patterns of resection deserve further exploration. This study provides a model for international benchmarking using clinical quality registries, although caution remains in the interpretation given disparities in data completeness.
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Affiliation(s)
- Michael Stenger
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.,OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Erik Jakobsen
- Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.,OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Gavin Wright
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - John Zalcberg
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robert G Stirling
- Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria, Australia.,Department of Medicine, Monash University, Melbourne, Victoria, Australia
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Moret A, Madelaine L, Cottenet J, Sophie Mariet A, Quantin C, Bernard A, Pagès PB. [Readmissions after lung resection in France: The PMSI database]. Rev Mal Respir 2021; 38:673-680. [PMID: 34175166 DOI: 10.1016/j.rmr.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Readmission within 30 days is an indicator of the quality of care, because it often reflects post-discharge care that is not optimal. The objective of this work is to measure over time on the one hand the readmission rate and on the other hand the number of hospitals with a standardized readmission rate beyond the national average. METHOD All patients with major pulmonary resection for lung cancer in France were extracted from the PMSI national database. Readmission within 30 days was defined as any new hospitalization either in the same hospital or in another establishment. RESULTS From January 1, 2005 to December 31, 2018, 110,603 patients were included. The 30-day all-cause readmissions rate was 24.9% (n=27,540). Patients after pneumonectomy had a readmission rate of 37% (n=4918) and 23% after lobectomy (n=2684) (P<0.0001). For the first period, we counted 10 hospitals with a standardized readmissions rate above the 99.8 limit and 10 hospitals above the 95% limit. For the second period, 8 hospitals had a standardized readmission rate above the 99.8% limit and 11 hospitals above the 95% limit. For the third period, 7 hospitals had a standardized readmission rate above the 99.8% limit and 6 hospitals above the 95% limit. CONCLUSION Readmissions to hospital 30 days after major lung resection for cancer in France declined little during these three periods. Measures to prevent readmissions should be introduced.
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Affiliation(s)
- A Moret
- Service de chirurgie thoracique et cardio-vasculaire, CHU Dijon, Dijon, France
| | - L Madelaine
- Service de chirurgie thoracique et cardio-vasculaire, CHU Dijon, Dijon, France; Inserm UMR 1231, université de Bourgogne, Dijon, France
| | - J Cottenet
- Departement de biostatistique, CHU Bocage, Université de Bourgogne, Dijon, France
| | - A Sophie Mariet
- Departement de biostatistique, CHU Bocage, Université de Bourgogne, Dijon, France
| | - C Quantin
- Departement de biostatistique, CHU Bocage, Université de Bourgogne, Dijon, France; Inserm, CIC 1432, Centre d'investigation clinique, hôpital de Dijon, université de Bourgogne, Dijon, France; Inserm, UVSQ, Institut Pasteur, université Paris-Saclay, Paris, France
| | - A Bernard
- Service de chirurgie thoracique et cardio-vasculaire, CHU Dijon, Dijon, France.
| | - P B Pagès
- Service de chirurgie thoracique et cardio-vasculaire, CHU Dijon, Dijon, France; Inserm UMR 1231, université de Bourgogne, Dijon, France
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Berna P, Quesnel C, Assouad J, Bagan P, Etienne H, Fourdrain A, Le Guen M, Leone M, Lorne E, Nguyen YNL, Pages PB, Roz H, Garnier M. Guidelines on enhanced recovery after pulmonary lobectomy. Anaesth Crit Care Pain Med 2021; 40:100791. [PMID: 33451912 DOI: 10.1016/j.accpm.2020.100791] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To establish recommendations for optimisation of the management of patients undergoing pulmonary lobectomy, particularly Enhanced Recovery After Surgery (ERAS). DESIGN A consensus committee of 13 experts from the French Society of Anaesthesia and Intensive Care Medicine (Soci,t, franOaise d'anesth,sie et de r,animation, SFAR) and the French Society of Thoracic and Cardiovascular Surgery (Soci,t, franOaise de chirurgie thoracique et cardiovasculaire, SFCTCV) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. METHODS Five domains were defined: 1) patient pathway and patient information; 2) preoperative management and rehabilitation; 3) anaesthesia and analgesia for lobectomy; 4) surgical strategy for lobectomy; and 5) enhanced recovery after surgery. For each domain, the objective of the recommendations was to address a number of questions formulated according to the PICO model (Population, Intervention, Comparison, Outcome). An extensive literature search on these questions was carried out and analysed using the GRADE® methodology. Recommendations were formulated according to the GRADE® methodology, and were then voted by all experts according to the GRADE grid method. RESULTS The SFAR/SFCTCV guideline panel provided 32 recommendations on the management of patients undergoing pulmonary lobectomy. After two voting rounds and several amendments, a strong consensus was reached for 31 of the 32 recommendations and a moderate consensus was reached for the last recommendation. Seven of these recommendations present a high level of evidence (GRADE 1+), 23 have a moderate level of evidence (18 GRADE 2+ and 5 GRADE 2-), and 2 correspond to expert opinions. Finally, no recommendation was provided for 2 of the questions. CONCLUSIONS A strong consensus was expressed by the experts to provide recommendations to optimise the whole perioperative management of patients undergoing pulmonary lobectomy.
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Affiliation(s)
- Pascal Berna
- Department of Thoracic Surgery, Amiens University Hospital, 80000 Amiens, France
| | - Christophe Quesnel
- Sorbonne Universit,, APHP, DMU DREAM, Service d'Anesth,sie-R,animation et M,decine P,riop,ratoire, H"pital Tenon, 75020 Paris, France
| | - Jalal Assouad
- Department of Thoracic Surgery, Tenon University Hospital, Sorbonne Universit,, 75020 Paris, France
| | - Patrick Bagan
- Department of Thoracic and Vascular Surgery, Victor Dupouy Hospital, 95100 Argenteuil, France
| | - Harry Etienne
- Department of Thoracic Surgery, Tenon University Hospital, Sorbonne Universit,, 75020 Paris, France
| | - Alex Fourdrain
- Department of Thoracic Surgery, Amiens University Hospital, 80000 Amiens, France
| | - Morgan Le Guen
- D,partement d'Anesth,sie, H"pital Foch, Universit, Versailles Saint Quentin, 92150 Suresnes, France; INRA UMR 892 VIM, 78350 Jouy-en-Josas, France
| | - Marc Leone
- Aix Marseille Universit, - Assistance Publique H"pitaux de Marseille - Service d'Anesth,sie et de R,animation - H"pital Nord - 13005 Marseille, France
| | - Emmanuel Lorne
- Departement d'Anesth,sie-R,animation, Clinique du Mill,naire, 34000 Montpellier, France
| | - Y N-Lan Nguyen
- Anaesthesiology and Critical Care Department, APHP Centre, Paris University, 75000 Paris, France
| | - Pierre-Benoit Pages
- Department of Thoracic Surgery, Dijon Burgundy University Hospital, 21000 Dijon, France; INSERM UMR 1231, Dijon Burgundy University Hospital, University of Burgundy, 21000 Dijon, France
| | - Hadrien Roz
- Unit, d'Anesth,sie R,animation Thoracique, H"pital Haut Leveque, CHU de Bordeaux, 33000 Bordeaux, France
| | - Marc Garnier
- Sorbonne Universit,, APHP, DMU DREAM, Service d'Anesth,sie-R,animation et M,decine P,riop,ratoire, H"pital Tenon, 75020 Paris, France.
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Walter J, Tufman A, Holle R, Schwarzkopf L. Differences in therapy and survival between lung cancer patients treated in hospitals with high and low patient case volume. Health Policy 2020; 124:1217-1225. [PMID: 32928583 DOI: 10.1016/j.healthpol.2020.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 05/26/2020] [Accepted: 07/27/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND In light of political discussions about minimum case volumes and certified lung cancer centers, this observational study investigates differences in therapy and survival between high vs. low patient volume hospitals (HPVH vs. LPVH). METHODS We identified 12,374 lung cancer patients treated in HPVH (>67 patients) and LPVH in 2013 from German health insurance claims. Stratified by metastasis status (no metastases, nodal metastases, systemic metastases), we compared HPVHs and LPVHs regarding likelihood of resection and systemic therapy, type of systemic therapy, and surgical outcomes, using multivariate logistic models. Three-year survival was modeled using Cox regression. We adjusted all regression models for age, gender, comorbidity, and residence area, and included a cluster variable for the hospital. RESULTS Around 24 % of patients were treated in HPVHs. Irrespective of stratum and subgroup, three-year survival was significantly better in HPVHs. In patients with systemic metastases (OR = 1.84, CI=[1.22,2.76]) and without metastases (OR = 3.28, CI=[2.13, 5.04]), resection was more likely in HPVHs. Among patients with systemic therapy, the odds of receiving pemetrexed was higher in HPVHs, in patients with nodal metastases (OR = 1.57, CI=[1.01,2.45]). In resected patients without metastases the odds ratio of receiving a thoracoscopic lobectomy was 2.28 (CI=[1.04,4.99]) in HPVHs. CONCLUSION Our data suggests that case volume is clinically relevant in resected and non-resected lung cancer patients, but optimal minimum case volumes may differ for subgroups.
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Affiliation(s)
- Julia Walter
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management (IGM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; Ludwig-Maximilians-University Hospital (LMU) Munich, Medical Clinic V - Pneumology, Ziemssenstr. 1, 80336 München, Germany; Ludwig-Maximilians-University Hospital (LMU) Munich, Department of Thoracic Surgery, Marchioninistraße 15, 81377 München, Germany; German Center for Lung Research (DZL), Aulweg 130, 35392 Gießen, Germany.
| | - Amanda Tufman
- Ludwig-Maximilians-University Hospital (LMU) Munich, Medical Clinic V - Pneumology, Ziemssenstr. 1, 80336 München, Germany; German Center for Lung Research (DZL), Aulweg 130, 35392 Gießen, Germany.
| | - Rolf Holle
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management (IGM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany.
| | - Larissa Schwarzkopf
- German Research Center for Environmental Health, Institute for Health Economics and Health Care Management (IGM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany; German Center for Lung Research (DZL), Aulweg 130, 35392 Gießen, Germany; IFT Institut für Therapieforschung, Leopoldstraße 175, 80804 Munich, Germany.
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Berghmans T, Lievens Y, Aapro M, Baird AM, Beishon M, Calabrese F, Dégi C, Delgado Bolton RC, Gaga M, Lövey J, Luciani A, Pereira P, Prosch H, Saar M, Shackcloth M, Tabak-Houwaard G, Costa A, Poortmans P. European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC): Lung cancer. Lung Cancer 2020; 150:221-239. [PMID: 33227525 DOI: 10.1016/j.lungcan.2020.08.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 08/26/2020] [Indexed: 12/24/2022]
Abstract
European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give patients, health professionals, managers and policymakers a guide to essential care throughout the patient journey. Lung cancer is the leading cause of cancer mortality and has a wide variation in treatment and outcomes in Europe. It is a major healthcare burden and has complex diagnosis and treatment challenges. Care must only be carried out in lung cancer units or centres that have a core multidisciplinary team (MDT) and an extended team of health professionals detailed here. Such units are far from universal in European countries. To meet European aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.
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Affiliation(s)
- Thierry Berghmans
- European Organisation for Research and Treatment of Cancer (EORTC); Thoracic Oncology Clinic, Institut Jules Bordet, Brussels, Belgium
| | - Yolande Lievens
- European Society for Radiotherapy and Oncology (ESTRO); Radiation Oncology Department, Ghent University Hospital, Belgium
| | - Matti Aapro
- European Cancer Organisation; Genolier Cancer Center, Genolier, Switzerland
| | - Anne-Marie Baird
- European Cancer Organisation Patient Advisory Committee; Central Pathology Laboratory, St James's Hospital, Dublin, Ireland
| | - Marc Beishon
- Cancer World, European School of Oncology (ESO), Milan, Italy.
| | - Fiorella Calabrese
- European Society of Pathology (ESP); Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italy
| | - Csaba Dégi
- International Psycho-Oncology Society (IPOS); Faculty of Sociology and Social Work, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Roberto C Delgado Bolton
- European Association of Nuclear Medicine (EANM); Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, San Pedro Hospital and Centre for Biomedical Research of La Rioja (CIBIR); University of La Rioja, Logroño, La Rioja, Spain
| | - Mina Gaga
- European Respiratory Society (ERS); 7th Respiratory Medicine Department, Athens Chest Hospital Sotiria, Athens, Greece
| | - József Lövey
- Organisation of European Cancer Institutes (OECI); National Institute of Oncology, Budapest, Hungary
| | - Andrea Luciani
- International Society of Geriatric Oncology (SIOG); Medical Oncology, Ospedale S. Paolo, Milan, Italy
| | - Philippe Pereira
- Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Clinic for Radiology, Minimally-Invasive Therapies and Nuclear Medicine, SLK-Kliniken, Heilbronn, Germany
| | - Helmut Prosch
- European Society of Radiology (ESR); Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - Marika Saar
- European Society of Oncology Pharmacy (ESOP); Tartu University Hospital, Tartu, Estonia
| | - Michael Shackcloth
- European Society of Surgical Oncology (ESSO); Department of Thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | | | - Philip Poortmans
- European Cancer Organisation; Iridium Kankernetwerk and University of Antwerp, Wilrijk-Antwerp, Belgium
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11
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Baum P, Diers J, Haag J, Klotz L, Eichhorn F, Eichhorn M, Wiegering A, Winter H. Nationwide effect of high procedure volume in lung cancer surgery on in-house mortality in Germany. Lung Cancer 2020; 149:78-83. [PMID: 32980612 DOI: 10.1016/j.lungcan.2020.08.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND The literature reports that hospital caseload volume is associated with survival for lung cancer resection. The aim of this study is to explore this association in a nationwide setting according to individual hospital caseload volume of every inpatient case in Germany. METHODS This retrospective analysis of nationwide hospital discharge data in Germany between 2014 and 2017 comprises 121,837 patients of whom 36,051 (29.6 %) underwent surgical anatomic resection. Hospital volumes were defined according to the number of patient resections for lung cancer in each hospital, and patients were categorized into 5 quintiles based on hospital caseload volume. A logistic regression model accounting for death according to sex, age, comorbidity, and resection volume was calculated, and effect modification was evaluated using the Mantel-Haenszel method. RESULTS In-house mortality ranged from 2.1 % in very high-volume centers to 4.0 % in very low-volume hospitals (p < 0.01). In multivariable logistic regression analysis, lower in-house mortality in very high-volume centers performing > 140 anatomic lung resections per year was observed compared with very low-volume centers performing < 27 resections (OR, 0.58; CI, 0.46 to 0.72; p < 0.01). This relationship also held for failure to rescue rates (12.9 vs 16.7 %, p = 0.01), although a greater number of extended resections were performed (23.1 vs. 14.8 %, p < 0.01). CONCLUSIONS Hospitals with high volumes of lung cancer resections performed surgery with a higher ratio of complex procedures and achieved reduced in-house mortality, fewer complications, and lower failure to rescue rates.
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Affiliation(s)
- Philip Baum
- Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Hospital, Roentgenstrasse 1, 69126 Heidelberg, Germany.
| | - Johannes Diers
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberduerrbacher Straße 6, 97080 Wuerzburg, Germany.
| | - Johannes Haag
- Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Hospital, Roentgenstrasse 1, 69126 Heidelberg, Germany.
| | - Laura Klotz
- Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Hospital, Roentgenstrasse 1, 69126 Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120 Heidelberg, Germany.
| | - Florian Eichhorn
- Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Hospital, Roentgenstrasse 1, 69126 Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120 Heidelberg, Germany.
| | - Martin Eichhorn
- Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Hospital, Roentgenstrasse 1, 69126 Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120 Heidelberg, Germany.
| | - Armin Wiegering
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberduerrbacher Straße 6, 97080 Wuerzburg, Germany.
| | - Hauke Winter
- Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Hospital, Roentgenstrasse 1, 69126 Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120 Heidelberg, Germany.
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12
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Rea F, Ieva F, Pastorino U, Apolone G, Barni S, Merlino L, Franchi M, Corrao G. Number of lung resections performed and long-term mortality rates of patients after lung cancer surgery: evidence from an Italian investigation. Eur J Cardiothorac Surg 2020; 58:70-77. [PMID: 32034907 DOI: 10.1093/ejcts/ezaa031] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/18/2019] [Accepted: 12/25/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Although it has been postulated that patients might benefit from the centralization of high-volume specialized centres, conflicting results have been reported on the relationship between the number of lung resections performed and the long-term, all-cause mortality rates among patients who underwent surgery for lung cancer. A population-based observational study was performed to contribute to the ongoing debate. METHODS The 2613 patients, all residents of the Lombardy region (Italy), who underwent lung resection for lung cancer from 2012 to 2014 were entered into the cohort and were followed until 2018. The hospitals were classified according to the annual number of pulmonary resections performed. Three categories of lung resection cases were identified: low (≤30), intermediate (31-95) and high (>95). The outcome of interest was all-cause death. A frailty model was used to estimate the death risk associated with the categories of numbers of lung resections performed, taking into account the multilevel structure of the data. A set of sensitivity analyses was performed to account for sources of systematic uncertainty. RESULTS The 1-year and 5-year survival rates of cohort members were 90% and 63%. Patients operated on in high-volume centres were on average younger and more often women. Compared to patients operated on in a low-volume centre, the mortality risk exhibited a significant, progressive reduction as the numbers of lung resections performed increased to intermediate (-13%; 95% confidence interval +10% to -31%) and high (-26%; 0% to -45%). Sensitivity analyses revealed that the association was consistent. CONCLUSIONS Further evidence that the volume of lung resection cases performed strongly affects the long-term survival of lung cancer patients has been supplied.
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Affiliation(s)
- Federico Rea
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy.,Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Francesca Ieva
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy.,MOX, Department of Mathematics, Politecnico di Milano, Milan, Italy.,CADS-Center for Analysis Decisions and Society, Human Technopole, Milan, Italy
| | - Ugo Pastorino
- Thoracic Surgery Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | | | - Sandro Barni
- Department of Oncology, ASST Bergamo Ovest, Bergamo, Italy
| | - Luca Merlino
- Epidemiologic Observatory, Lombardy Regional Health Service, Milan, Italy
| | - Matteo Franchi
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy.,Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, Milan, Italy.,Laboratory of Healthcare Research & Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
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13
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Ely S, Jiang SF, Patel AR, Ashiku SK, Velotta JB. Regionalization of Lung Cancer Surgery Improves Outcomes in an Integrated Health Care System. Ann Thorac Surg 2020; 110:276-283. [DOI: 10.1016/j.athoracsur.2020.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 01/10/2020] [Accepted: 02/06/2020] [Indexed: 11/16/2022]
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14
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Impact on survival of modelling increased surgical resection rates in patients with non-small-cell lung cancer and cardiovascular comorbidities: a VICORI study. Br J Cancer 2020; 123:471-479. [PMID: 32390010 PMCID: PMC7403296 DOI: 10.1038/s41416-020-0869-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 03/20/2020] [Accepted: 04/16/2020] [Indexed: 11/13/2022] Open
Abstract
Background The impact of cardiovascular disease (CVD) comorbidity on resection rates and survival for patients with early-stage non-small-cell lung cancer (NSCLC) is unclear. We explored if CVD comorbidity explained surgical resection rate variation and the impact on survival if resection rates increased. Methods Cancer registry data consisted of English patients diagnosed with NSCLC from 2012 to 2016. Linked hospital records identified CVD comorbidities. We investigated resection rate variation by geographical region using funnel plots; resection and death rates using time-to-event analysis. We modelled an increased propensity for resection in regions with the lowest resection rates and estimated survival change. Results Among 57,373 patients with Stage 1−3A NSCLC, resection rates varied considerably between regions. Patients with CVD comorbidity had lower resection rates and higher mortality rates. CVD comorbidity explained only 1.9% of the variation in resection rates. For every 100 CVD comorbid patients, increasing resection in regions with the lowest rates from 24 to 44% would result in 16 more patients resected and alive after 1 year and two fewer deaths overall. Conclusions Variation in regional resection rate is not explained by CVD comorbidities. Increasing resection in patients with CVD comorbidity to the levels of the highest resecting region would increase 1-year survival.
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15
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Palma DA, Nguyen TK, Louie AV, Malthaner R, Fortin D, Rodrigues GB, Yaremko B, Laba J, Kwan K, Gaede S, Lee T, Ward A, Warner A, Inculet R. Measuring the Integration of Stereotactic Ablative Radiotherapy Plus Surgery for Early-Stage Non-Small Cell Lung Cancer: A Phase 2 Clinical Trial. JAMA Oncol 2020; 5:681-688. [PMID: 30789648 DOI: 10.1001/jamaoncol.2018.6993] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Stereotactic ablative radiotherapy (SABR) is a standard treatment option in patients with medically inoperable early-stage non-small cell lung cancer (NSCLC), yet the pathologic complete response (pCR) rate after SABR is unknown. Neoadjuvant SABR in patients with cancer who are fit for resection has been hypothesized to improve local control and induce antitumor immune activity, potentially leading to better outcomes. Objectives To determine the pCR rate after SABR and to assess oncologic and toxicity outcomes after a combined approach of neoadjuvant SABR followed by surgery. Design, Setting, and Participants A phase 2, single-arm trial, with patient accrual from September 30, 2014, to August 15, 2017 (median follow-up, 19 months), was performed at a tertiary academic cancer center. Patients 18 years or older with T1T2N0M0 NSCLC and good performance status, with adequate pulmonary reserve to undergo surgical resection, were studied. Interventions Patients underwent neoadjuvant SABR using a risk-adapted fractionation scheme followed by surgery 10 weeks later. Main Outcomes and Measures The pCR rate as determined by hematoxylin-eosin staining. Results Forty patients (mean [SD] age, 68 [8] years; 23 [58%] female) were enrolled. Thirty-five patients underwent surgery and were evaluable for the primary end point. The pCR rate was 60% (95% CI, 44%-76%). The 30- and 90-day postoperative mortality rates were both 0%. Grade 3 or 4 toxic effects occurred in 7 patients (18%). In patients receiving surgery, 2-year overall survival was 77% (95% CI, 48%-91%), local control was 100% (95% CI, not defined), regional control was 53% (95% CI, 22%-76%), and distant control was 76% (95% CI, 45%-91%). Quality of life did not decline after treatment, with no significant changes in mean Functional Assessment of Cancer Therapy for Lung-Trial Outcome Index score during the first year of follow-up. Conclusions and Relevance The pCR rate after SABR for early-stage NSCLC was 60%, lower than hypothesized. The combined approach had toxic effects comparable to series of surgery alone, and there was no perioperative mortality. Further studies are needed to evaluate this combined approach compared with surgical resection alone. Trial Registration ClinicalTrials.gov identifier: NCT02136355.
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Affiliation(s)
- David A Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, Western University, London, Ontario, Canada
| | - Timothy K Nguyen
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.,Currently with Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, Western University, London, Ontario, Canada.,Currently with Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Richard Malthaner
- Department of Surgery, Division of Thoracic Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Dalilah Fortin
- Department of Surgery, Division of Thoracic Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - George B Rodrigues
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, Western University, London, Ontario, Canada
| | - Brian Yaremko
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, Western University, London, Ontario, Canada
| | - Joanna Laba
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.,Department of Oncology, Western University, London, Ontario, Canada
| | - Keith Kwan
- Department of Pathology, Western University, London, Ontario, Canada
| | - Stewart Gaede
- Department of Oncology, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada.,Department of Physics and Engineering, Western University, London, Ontario, Canada
| | - Ting Lee
- Department of Oncology, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Aaron Ward
- Department of Oncology, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Richard Inculet
- Department of Surgery, Division of Thoracic Surgery, London Health Sciences Centre, London, Ontario, Canada
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16
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Matsuo K, Matsuzaki S, Mandelbaum RS, Matsushima K, Klar M, Grubbs BH, Roman LD, Wright JD. Association between hospital surgical volume and perioperative outcomes of fertility-sparing trachelectomy for cervical cancer: A national study in the United States. Gynecol Oncol 2020; 157:173-180. [PMID: 31982179 DOI: 10.1016/j.ygyno.2020.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/04/2020] [Accepted: 01/06/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To examine the association between hospital surgical volume and perioperative outcomes for fertility-sparing trachelectomy performed for cervical cancer. METHODS This is a population-based retrospective observational study utilizing the Nationwide Inpatient Sample from 2001 to 2011. Women aged ≤45 years with cervical cancer who underwent trachelectomy were included. Annualized hospital surgical volume was defined as the average number of trachelectomies a hospital performed per year in which at least one case was performed. Perioperative outcomes were assessed based on hospital surgical volume in a weighted model, specifically comparing the top-decile centers to the lower volume centers. RESULTS There were a total of 815 trachelectomies performed at 89 centers, and 76.4% of the trachelectomy-performing centers had a minimum surgical volume of one trachelectomy per year. The top-decile group had a higher rate of lymphadenectomy performance compared to the lower volume group (96.4% versus 82.4%, odds ratio [OR] 5.65, 95% confidence interval [CI] 2.81-11.4, P < 0.001). There was a significant inverse linear association between annualized surgical volume and the number of perioperative complications (P = 0.020). The top-decile group also had a lower rate of perioperative complications (9.7% versus 21.0%, P < 0.001) and prolonged hospital stay ≥7 days (2.0% versus 6.5%, P = 0.006) compared to the lower volume group. In a multivariable analysis, the top-decile group had a 65% relative decrease in perioperative complication risk compared to the lower volume group (adjusted-OR 0.35, 95%CI 0.20-0.59, P < 0.001). CONCLUSION Fertility-sparing trachelectomy for young women with cervical cancer is a rare surgical procedure; <90 centers performed this procedure from 2001 to 2011 and most hospitals perform a small number of cases annually. Higher hospital surgical volume for trachelectomy may be associated with reduced perioperative morbidity.
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Affiliation(s)
- Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
| | - Shinya Matsuzaki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Rachel S Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University of Freiburg, Freiburg, Germany
| | - Brendan H Grubbs
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
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Stirling R, Stenger M, Zalcberg J. Comment on: 'Hospital lung surgery volume and patient outcomes'. Lung Cancer 2020; 142:138-139. [PMID: 31928734 DOI: 10.1016/j.lungcan.2020.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 12/23/2019] [Accepted: 01/02/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Rob Stirling
- Department of Respiratory Medicine, The Alfred Hospital, Australia; Department of Medicine, Monash University, Australia.
| | - Michael Stenger
- Department of Epidemiology and Preventive Medicine, Monash University, Australia
| | - John Zalcberg
- Department of Respiratory Medicine, The Alfred Hospital, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Australia
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18
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Virgilsen LF, Møller H, Vedsted P. Travel distance to cancer-diagnostic facilities and tumour stage. Health Place 2019; 60:102208. [DOI: 10.1016/j.healthplace.2019.102208] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 01/01/2023]
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19
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Goulden R, Whitehouse T, Murphy N, Hayton T, Khan Z, Snelson C, Bion J, Veenith T. Association Between Hospital Volume and Mortality in Status Epilepticus: A National Cohort Study. Crit Care Med 2019; 46:1969-1976. [PMID: 30134302 DOI: 10.1097/ccm.0000000000003392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES In various medical and surgical conditions, research has found that centers with higher patient volumes have better outcomes. This relationship has not previously been explored for status epilepticus. This study sought to examine whether centers that see higher volumes of patients with status epilepticus have lower in-hospital mortality than low-volume centers. DESIGN Cohort study, using 2010-2015 data from the nationwide Case Mix Programme database of the U.K.'s Intensive Care National Audit and Research Centre. SETTING Greater than 90% of ICUs in United Kingdom, Wales, and Northern Ireland. PATIENTS Twenty-thousand nine-hundred twenty-two adult critical care admissions with a primary or secondary diagnosis of status epilepticus or prolonged seizure. INTERVENTIONS Annual hospital status epilepticus admission volume. MEASUREMENTS AND MAIN RESULTS We used multiple logistic regression to evaluate the association between hospital annual status epilepticus admission volume and in-hospital mortality. Hospital volume was modeled as a nonlinear variable using restricted cubic splines, and generalized estimating equations with robust SEs were used to account for clustering by institution. There were 2,462 in-hospital deaths (11.8%). There was no significant association between treatment volume and in-hospital mortality for status epilepticus (p = 0.54). This conclusion was unchanged across a number of subgroup and sensitivity analyses, although we lacked data on seizure duration and medication use. Secondary analyses suggest that many high-risk patients were already transferred from low- to high-volume centers. CONCLUSIONS We find no evidence that higher volume centers are associated with lower mortality in status epilepticus overall. It is likely that national guidelines and local pathways in the United Kingdom allow efficient patient transfer from smaller centers like district general hospitals to provide satisfactory patient care in status epilepticus. Future research using more granular data should explore this association for the subgroup of patients with refractory and superrefractory status epilepticus.
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Affiliation(s)
- Robert Goulden
- Department of Critical Care Medicine, University Hospital of Birmingham NHS trust, Birmingham, United Kingdom.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Tony Whitehouse
- Department of Critical Care Medicine, University Hospital of Birmingham NHS trust, Birmingham, United Kingdom
| | - Nick Murphy
- Department of Critical Care Medicine, University Hospital of Birmingham NHS trust, Birmingham, United Kingdom.,Perioperative and Critical Care Research Group, University of Birmingham, Birmingham, United Kingdom
| | - Tom Hayton
- Department of Critical Care Medicine, University Hospital of Birmingham NHS trust, Birmingham, United Kingdom.,Perioperative and Critical Care Research Group, University of Birmingham, Birmingham, United Kingdom
| | - Zahid Khan
- Department of Critical Care Medicine, University Hospital of Birmingham NHS trust, Birmingham, United Kingdom
| | - Catherine Snelson
- Department of Critical Care Medicine, University Hospital of Birmingham NHS trust, Birmingham, United Kingdom
| | - Julian Bion
- Department of Critical Care Medicine, University Hospital of Birmingham NHS trust, Birmingham, United Kingdom.,Perioperative and Critical Care Research Group, University of Birmingham, Birmingham, United Kingdom
| | - Tonny Veenith
- Department of Critical Care Medicine, University Hospital of Birmingham NHS trust, Birmingham, United Kingdom.,Perioperative and Critical Care Research Group, University of Birmingham, Birmingham, United Kingdom
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20
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Impact of health care organization on surgical lung cancer care. Lung Cancer 2019; 135:181-187. [DOI: 10.1016/j.lungcan.2019.07.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/25/2019] [Accepted: 07/28/2019] [Indexed: 11/24/2022]
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21
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Jarrar M, Al‐Bsheish M, Dardas LA, Meri A, Sobri Minai M. Adverse events in Malaysia: Associations with nurse's ethnicity and experience, hospital size, accreditation, and teaching status. Int J Health Plann Manage 2019; 35:104-119. [DOI: 10.1002/hpm.2822] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 02/03/2023] Open
Affiliation(s)
- Mu'taman Jarrar
- Vice Deanship for Quality and Development, College of MedicineImam Abdulrahman Bin Faisal University Dammam Saudi Arabia
- Medical--> Education DepartmentKing Fahd Hospital of the University Al‐Khobar Saudi Arabia
| | - Mohammad Al‐Bsheish
- Healthcare Administration DepartmentBatterjee Medical College Jeddah Saudi Arabia
| | - Latefa Ali Dardas
- Community Mental Health Nursing Department, School of NursingThe University of Jordan Amman Jordan
| | - Ahmed Meri
- Department of Medical Instrumentation Techniques EngineeringAl‐Hussain University College Karbala Iraq
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22
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Thai A, Stuart E, te Marvelde L, Milne R, Knight S, Whitfield K, Mitchell P. Hospital lung surgery volume and patient outcomes. Lung Cancer 2019; 129:22-27. [DOI: 10.1016/j.lungcan.2019.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/03/2018] [Accepted: 01/08/2019] [Indexed: 11/30/2022]
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23
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Powell HA. Socioeconomic deprivation and inequalities in lung cancer: time to delve deeper? Thorax 2018; 74:11-12. [PMID: 30381398 DOI: 10.1136/thoraxjnl-2018-212362] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Helen A Powell
- Thoracic Medicine, Frimley Park Hospital, Frimley Health NHS Foundation Trust, Frimley
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24
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Bernard A, Cottenet J, Mariet AS, Quantin C, Pagès PB. Is an activity volume threshold really realistic for lung cancer resection? J Thorac Dis 2018; 10:5685-5694. [PMID: 30505476 DOI: 10.21037/jtd.2018.09.77] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background We analyzed volume as a continuous variable to estimate threshold, which is a methodology rarely seen in the literature. The objective of this work was to assess hospital volume for lung cancer (LC) surgery and to establish the associated threshold for acceptable in-hospital mortality (IHM). Data was obtained from the French national medico-administrative database. Methods From January 2005 to December 2016, data from 108,571 patients operated for LC in France were collected from the national administrative database. To estimate the volume threshold, hierarchical logistic regression models were developed. Results The crude IHM rate was 5.2% in low volume centers and 3.5% in high volume centers (P<0.0001). Centers performing more than 70 LC surgeries per year reduced the risk of postoperative death by 35% [adjusted odds ratio (OR): 0.65; 95% confidence interval (CI): 0.5-0.84]. Among the 4 models, the use of fractional polynomial of the volume had the lowest Akaike's information criterion (AIC) index. The threshold volume was reached once a hospital's annual volume reached 70 patients (95% CI, 40-85). In our analyses, the proportion of patients who were admitted in hospitals with an annual volume that was less than identified threshold were 34% of patients operated for LC. A hospital with an annual volume of 10 patients for lung resection, increasing the annual volume by 60 procedures would be associated with a 31% reduction in the odds of death within 30 days. Conclusions From the medico-administrative database, we have been able to estimate a minimum volume threshold that may be useful to help regionalize thoracic surgery centers.
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Affiliation(s)
- Alain Bernard
- Department of Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Jonathan Cottenet
- Department of Biostatistics and Medical Informatics, Dijon University Hospital, Dijon, France
| | - Anne-Sophie Mariet
- Department of Biostatistics and Medical Informatics, Dijon University Hospital, Dijon, France
| | - Catherine Quantin
- Department of Biostatistics and Medical Informatics, Dijon University Hospital, Dijon, France.,INSERM, CIC 1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, University of Burgundy, Dijon, France.,INSERM UMR 1181, "Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases", Dijon University Hospital, University of Burgundy, Dijon, France
| | - Pierre-Benoit Pagès
- Department of Thoracic Surgery, Dijon University Hospital, Dijon, France.,INSERM UMR 866, Dijon University Hospital, University of Burgundy, Dijon, France
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Bittermann T, Hubbard RA, Serper M, Lewis JD, Hohmann SF, VanWagner LB, Goldberg DS. Healthcare utilization after liver transplantation is highly variable among both centers and recipients. Am J Transplant 2018; 18:1197-1205. [PMID: 29024364 PMCID: PMC5895535 DOI: 10.1111/ajt.14539] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/26/2017] [Accepted: 10/03/2017] [Indexed: 01/25/2023]
Abstract
The relationship between healthcare utilization before and after liver transplantation (LT), and its association with center characteristics, is incompletely understood. This was a retrospective cohort study of 34 402 adult LTs between 2002 and 2013 using Vizient inpatient claims data linked to the United Network for Organ Sharing (UNOS) database. Multivariable mixed-effects linear regression models evaluated the association between hospitalization 90 days pre-LT and the number of days alive and out of the hospital (DAOH) 1 year post-LT. Of those patients alive at LT discharge, 24.7% spent ≥30 days hospitalized during the first year. Hospitalization in the 90 days pre-LT was inversely associated with DAOH (β = -3.4 DAOH/week hospitalized pre-LT; P = .002). Centers with >30% of their liver transplant recipients hospitalized ≥30 days in the first LT year were typically smaller volume and/or transplanting higher risk recipients (Model for End-Stage Liver Disease [MELD] score ≥35, inpatient or ventilated pre-LT). In conclusion, pre-LT hospitalization predicts 1-year post-LT hospitalization independent of MELD score at the patient-level, whereas center-specific post-LT healthcare utilization is associated with certain center behaviors and selection practices.
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Affiliation(s)
- T Bittermann
- Division of Gastroenterology & Hepatology, University of Pennsylvania, Philadelphia, PA, USA
| | - R A Hubbard
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
- Division of Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - M Serper
- Division of Gastroenterology & Hepatology, University of Pennsylvania, Philadelphia, PA, USA
| | - J D Lewis
- Division of Gastroenterology & Hepatology, University of Pennsylvania, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - S F Hohmann
- Center for Advanced Analytics, Vizient, Chicago, IL, USA
| | - L B VanWagner
- Division of Gastroenterology & Hepatology and Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - D S Goldberg
- Division of Gastroenterology & Hepatology, University of Pennsylvania, Philadelphia, PA, USA
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
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26
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Verleye L, De Gendt C, Vrijens F, Schillemans V, Camberlin C, Silversmit G, Stordeur S, Van Eycken E, Dubois C, Robays J, Wauters I, Van Meerbeeck JP. Patterns of care for non-small cell lung cancer patients in Belgium: A population-based study. Eur J Cancer Care (Engl) 2017; 27. [PMID: 28833865 DOI: 10.1111/ecc.12747] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2017] [Indexed: 12/25/2022]
Abstract
Guidelines recommend surgery for Stage I-II, chemoradiation for Stage III and systemic therapy for Stage IV non-small cell lung cancer (NSCLC). However, patient related factors and patient preferences influence treatment decisions. We investigated patterns of care for Belgian NSCLC patients in 2010-2011, based on population-based data from the Belgian Cancer Registry and administrative databases. The relationship between patient characteristics, institutional diagnostic volume, type of treatment and survival was investigated. Overall, 20.8% of patients received no oncological treatment. 59% and 22.1% of Stage I-II patients received primary surgery or (chemo)radiation respectively. 34% of Stage III patients received chemoradiation and 17% of Stage IIIA patients had surgery. 70% of Stage IV patients received chemotherapy or targeted therapy. Moderate variability between centres was observed. For Stage IV, systemic therapy was less frequently used in higher volume centres and 1-year survival was lower in centres that had ≥ 50 new patients yearly. Although not all NSCLC patients received treatment as ideally recommended by guidelines, these results do not necessarily represent poor quality of care as patient characteristics and preferences need to be taken into account. Treatment options targeted towards patients with co-morbidity or unfit patients is warranted to improve outcomes of all NSCLC patients.
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Affiliation(s)
- L Verleye
- KCE - Belgian Health Care Knowledge Centre, Brussels, Belgium
| | - C De Gendt
- Belgian Cancer Registry, Brussels, Belgium
| | - F Vrijens
- KCE - Belgian Health Care Knowledge Centre, Brussels, Belgium
| | | | - C Camberlin
- KCE - Belgian Health Care Knowledge Centre, Brussels, Belgium
| | | | - S Stordeur
- KCE - Belgian Health Care Knowledge Centre, Brussels, Belgium
| | | | - C Dubois
- KCE - Belgian Health Care Knowledge Centre, Brussels, Belgium
| | - J Robays
- KCE - Belgian Health Care Knowledge Centre, Brussels, Belgium
| | - I Wauters
- Department of Respiratory Medicine, University Hospitals KU Leuven, Leuven, Belgium
| | - J P Van Meerbeeck
- Center for Oncological Research, University of Antwerp, Antwerp University Hospital, Antwerp Edegem, Belgium.,Thoraic Oncology, Antwerp University Hospital, Edegem, Belgium
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