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Klotz LV, Deissner H, Eichhorn F. [Gender medicine in lung diseases]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:730-735. [PMID: 39090448 DOI: 10.1007/s00104-024-02141-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 08/04/2024]
Abstract
Gender-specific differences in the diagnostics and treatment must be considered for various lung diseases. In the case of pneumothorax, in addition to differences in etiology there are also relevant differences in treatment and recurrence rates between men and women. For example, to achieve low recurrence rates catamenial pneumothorax requires interdisciplinary collaboration with gynecology. The incidence of lung cancer has equalized in recent years and in addition, various gender-specific prognostic factors have become relevant. Several meta-analyses have identified female gender as a positive prognostic factor for lung cancer, in addition to the higher prevalence of various driver mutations in women. In current trials of multimodal treatment for lung cancer, gender differences in tolerability and patient outcome are already apparent. In subgroup analyses better event-free survival was observed in women, although immune-mediated adverse events were more common in women.
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Affiliation(s)
- Laura V Klotz
- Klinik für Thoraxchirurgie, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
- Thoraxklinik, Universitätsklinikum Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Deutschland.
| | - Henrike Deissner
- Klinik für Thoraxchirurgie, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Florian Eichhorn
- Klinik für Thoraxchirurgie, Thoraxklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Teteh DK, Ferrell B, Okunowo O, Downie A, Erhunmwunsee L, Montgomery SB, Raz D, Kittles R, Kim JY, Sun V. Social determinants of health and lung cancer surgery: a qualitative study. Front Public Health 2023; 11:1285419. [PMID: 38026333 PMCID: PMC10644827 DOI: 10.3389/fpubh.2023.1285419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/05/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Social determinants of health (SDOH) are non-clinical factors that may affect the outcomes of cancer patients. The purpose of this study was to describe the influence of SDOH factors on quality of life (QOL)-related outcomes for lung cancer surgery patients. Methods Thirteen patients enrolled in a randomized trial of a dyadic self-management intervention were invited and agreed to participate in semi-structured key informant interviews at study completion (3 months post-discharge). A conventional content analysis approach was used to identify codes and themes that were derived from the interviews. Independent investigators coded the qualitative data, which were subsequently confirmed by a second group of independent investigators. Themes were finalized, and discrepancies were reviewed and resolved. Results Six themes, each with several subthemes, emerged. Overall, most participants were knowledgeable about the concept of SDOH and perceived that provider awareness of SDOH information was important for the delivery of comprehensive care in surgery. Some participants described financial challenges during treatment that were exacerbated by their cancer diagnosis and resulted in stress and poor QOL. The perceived impact of education varied and included its importance in navigating the healthcare system, decision-making on health behaviors, and more economic mobility opportunities. Some participants experienced barriers to accessing healthcare due to insurance coverage, travel burden, and the fear of losing quality insurance coverage due to retirement. Neighborhood and built environment factors such as safety, air quality, access to green space, and other environmental factors were perceived as important to QOL. Social support through families/friends and spiritual/religious communities was perceived as important to postoperative recovery. Discussion Among lung cancer surgery patients, SDOH factors can impact QOL and the patient's survivorship journey. Importantly, SDOH should be assessed routinely to identify patients with unmet needs across the five domains. SDOH-driven interventions are needed to address these unmet needs and to improve the QOL and quality of care for lung cancer surgery patients.
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Affiliation(s)
- Dede K. Teteh
- Department of Health Sciences, Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA, United States
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Betty Ferrell
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Oluwatimilehin Okunowo
- Division of Biostatistics, Department of Computational and Quantitative Medicine, Beckman Research Institute of City of Hope, Duarte, CA, United States
| | - Aidea Downie
- School of Public Health, Brown University, Providence, RI, United States
| | - Loretta Erhunmwunsee
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | | | - Dan Raz
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Rick Kittles
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, United States
| | - Jae Y. Kim
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Virginia Sun
- Division of Nursing Research and Education, Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
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Wish J, Villena-Vargas J, Harrison S, Lee B, Chow O, Port J, Altorki N, Stiles BM. Surgical Treatment at an Academic Medical Center is Associated with Statistically Insignificant Lung Cancer Survival Outcome Differences Related to ZIP Code. World J Surg 2023; 47:2052-2064. [PMID: 37046063 DOI: 10.1007/s00268-023-07006-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Low socioeconomic status is a well-characterized adverse prognostic factor in large lung cancer databases. However, such characterizations may be confounded as patients of lower socioeconomic status are more often treated at low-volume, non-academic centers. We evaluated whether socioeconomic status, as defined by ZIP code median income, was associated with differences in lung cancer resection outcomes within a high-volume academic medical center. METHODS Consecutive patients undergoing resection for non-small cell lung cancer were identified from a prospectively maintained database (2011-18). Patients were assigned an income value based on the median income of their ZIP code as determined by census-based geographic data. We stratified the population into income quintiles representative of SES and compared demographics (chi-square), surgical outcomes, and survival (Kaplan-Meier). RESULTS We identified 1,693 patients, representing 516 ZIP codes. Income quintiles were Q1: $24,421-53,151; Q2:$53,152-73,982; Q3:$73,983-99,063; Q4:$99,064-123,842; and Q5:$123,843-250,001. Compared to Q5 patients, Q1 patients were younger (median 69 vs. 73, p < 0.001), more likely male (44 vs. 36%, p = 0.035), and more likely Asian, Black, or self-identified as other than white, Asian, or Black. (67 vs. 11%, p = < 0.001). We found minor differences in surgical outcomes and no significant difference in 5-year survival between Q1 and Q5 patients (5-year: 86 vs. 85%, p = 0.886). CONCLUSIONS Surgical care patterns at a high-volume academic medical center are similar among patients from varying ZIP codes. Surgical treatment at such a center is associated with no survival differences based upon socioeconomic status as determined by ZIP code. Centralization of lung cancer surgical care to high-volume centers may reduce socioeconomic outcome disparities.
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Affiliation(s)
- Jack Wish
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA.
| | - Jonathan Villena-Vargas
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Sebron Harrison
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Ben Lee
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Oliver Chow
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Jeffrey Port
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Nasser Altorki
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Brendon M Stiles
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, 111 East 210th Street, New York, NY, 10467, USA
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Vedire YR, Shin S, Groman A, Hennon M, Dy GK, Yendamuri S. Survival Benefit of Perioperative Systemic Chemotherapy for Patients With N0 to N1 NSCLC Having Synchronous Brain Metastasis. JTO Clin Res Rep 2023; 4:100522. [PMID: 37275564 PMCID: PMC10238748 DOI: 10.1016/j.jtocrr.2023.100522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/14/2023] [Accepted: 04/24/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction In stage IV NSCLC with solitary or oligometastatic brain metastasis, surgical resection of the primary and definitive management of the brain metastasis is an accepted standard. However, the effect of systemic chemotherapy after surgical resection on overall survival is not well-established. Methods We used the National Cancer Database to retrospectively identify individuals with NSCLC as the primary tumor along with synchronous brain metastases who underwent thoracic resection with or without adjuvant chemotherapy. Chi-square and Wilcoxon rank sum tests were performed to compare categorical and continuous variables, respectively, across the treatment groups. Kaplan-Meier and Cox proportional modeling were done to determine the survival benefit. Results A total of 310 (71.9%) of the cohort received perioperative chemotherapy, most of whom (79.4%) received it in the adjuvant setting. Patients receiving chemotherapy were likely to be younger (p = 0.002), privately insured (p = 0.01), and receive radiation (p < 0.001). Perioperative chemotherapy was significantly associated with survival on both univariate (hazard ratio = 0.71[0.52 - 0.99]) and multivariable (hazard ratio = 0.66 [0.47 - 0.92]) in addition to age (p = 0.03), Charlson-Deyo score (p = 0.02), pathologic N stage (p = 0.02), and adenocarcinoma histology (p = 0.02). Kaplan-Meier analysis confirmed this result with a significantly better survival with perioperative chemotherapy (p = 0.02). Further subgroup analysis using pathologic N stage revealed similar effect in pN1 (p = 0.001), but not pN0 (p = 0.2) patients. Conclusions Perioperative chemotherapy for pN0-1 NSCLC with synchronous brain metastasis is associated with improved OS in this analysis.
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Affiliation(s)
- Yeshwanth R. Vedire
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York
| | - Sarah Shin
- Department of Medicine, Roswell Park Comprehensive Cancer Center at Buffalo, Buffalo, New York
| | - Adrienne Groman
- Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, New York
| | - Mark Hennon
- Department of Medicine, Roswell Park Comprehensive Cancer Center at Buffalo, Buffalo, New York
| | - Grace K. Dy
- Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York
| | - Sai Yendamuri
- Department of Medicine, Roswell Park Comprehensive Cancer Center at Buffalo, Buffalo, New York
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Wu HY, Chang CC, Yeh CC, Chen MY, Cherng YG, Chen TL, Liao CC. Adverse outcomes after non-hepatic surgeries in patients with alcoholic liver diseases: a propensity-score matched study. BMC Gastroenterol 2022; 22:475. [PMID: 36404314 PMCID: PMC9677632 DOI: 10.1186/s12876-022-02558-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 10/28/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The influence of alcoholic liver disease (ALD) on the postoperative outcomes is not completely understood. Our purpose is to evaluate the complications and mortality after nonhepatic surgeries in patients with ALD. METHODS We conducted a retrospective cohort study included adults aged 20 years and older who underwent nonhepatic elective surgeries using data of Taiwan's National Health Insurance, 2008-2013. Using a propensity-score matching procedure, we selected surgical patients with ALD (n = 26,802); or surgical patients without ALD (n = 26,802) for comparison. Logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of postoperative complications and in-hospital mortality associated with ALD. RESULTS Patients with ALD had higher risks of acute renal failure (OR 2.74, 95% CI 2.28-3.28), postoperative bleeding (OR 1.64, 95% CI 1.34-2.01), stroke (OR 1.51, 95% CI 1.34-1.70) septicemia (OR 1.47, 95% CI 1.36-1.58), pneumonia (OR 1.43, 95% CI 1.29-1.58), and in-hospital mortality (OR 2.64, 95% CI 2.24-3.11) than non-ALD patients. Patients with ALD also had longer hospital stays and higher medical expenditures after nonhepatic surgical procedures than the non-ALD patients. Compared with patients without ALD, patients with ALD who had jaundice (OR 4.82, 95% CI 3.68-6.32), ascites (OR 4.57, 95% CI 3.64-5.74), hepatic coma (OR 4.41, 95% CI 3.44-5.67), gastrointestinal hemorrhage (OR 3.84, 95% CI 3.09-4.79), and alcohol dependence syndrome (OR 3.07, 95% CI 2.39-3.94) were more likely to have increased postoperative mortality. CONCLUSION Surgical patients with ALD had more adverse events and a risk of in-hospital mortality after nonhepatic surgeries that was approximately 2.6-fold higher than that for non-ALD patients. These findings suggest the urgent need to revise the protocols for peri-operative care for this population.
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Affiliation(s)
- Hsin-Yun Wu
- grid.412896.00000 0000 9337 0481Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan ,grid.412896.00000 0000 9337 0481Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chuen-Chau Chang
- grid.412896.00000 0000 9337 0481Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan ,grid.412897.10000 0004 0639 0994Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan ,grid.412897.10000 0004 0639 0994Department of Anesthesiology, Taipei Medical University Hospital, 252 Wuxing St., Taipei, 11031 Taiwan
| | - Chun-Chieh Yeh
- grid.411508.90000 0004 0572 9415Team of Liver Transplantation, Department of Surgery, China Medical University Hospital, Taichung, Taiwan ,grid.185648.60000 0001 2175 0319Department of Surgery, University of Illinois, Chicago, USA
| | - Ming-Yao Chen
- grid.412896.00000 0000 9337 0481Division of Gastroenterology and Hepatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yih-Giun Cherng
- grid.412896.00000 0000 9337 0481Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan ,grid.412896.00000 0000 9337 0481Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ta-Liang Chen
- grid.412896.00000 0000 9337 0481Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan ,grid.412897.10000 0004 0639 0994Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan ,grid.412896.00000 0000 9337 0481Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chien-Chang Liao
- grid.412896.00000 0000 9337 0481Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan ,grid.412897.10000 0004 0639 0994Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan ,grid.412897.10000 0004 0639 0994Department of Anesthesiology, Taipei Medical University Hospital, 252 Wuxing St., Taipei, 11031 Taiwan ,grid.412896.00000 0000 9337 0481Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan ,grid.412896.00000 0000 9337 0481Centers of Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan ,grid.254145.30000 0001 0083 6092School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
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Goussault H, Gendarme S, Assié J, Jung C, Epaud S, Algans C, Salaun‐Penquer N, Rousseau M, Lazatti A, Chouaïd C. Risk factors for early mortality of lung cancer patients in France: A nationwide analysis. Cancer Med 2022; 11:5025-5034. [PMID: 35567378 PMCID: PMC9761075 DOI: 10.1002/cam4.4821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/08/2022] [Accepted: 04/26/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Despite therapeutic advances, lung cancer remains the first cause of death from cancer. The main objective of this study was to identify risk factors associated with death within 3-months of the first hospitalization for lung cancer in France. METHODS This analysis included patients with a first hospitalization for lung cancer (between January 1, 2016 and December 31, 2018) according to diagnosis-related groups entered into the French national medical-administrative database. Clinical and socioeconomic parameters and characteristics of that first hospitalization were analyzed. A model predictive of early mortality was developed based on those variables. RESULTS The 144,087 included patients were 67% men; median age of 68 [interquartile range 60-76] years; 47% had metastatic disease at diagnosis; and 34% and 23%, respectively, had received systemic treatment or undergone curative surgery. The 3-month mortality was 19%, and significantly higher for those ≥70 versus <70 years old (OR 1.33, 1.22-1.45), men versus. women (OR 1.50, 1.44-1.55), those with metastatic disease at diagnosis (OR, 3.30, 3.18-3.43), first hospitalization via the emergency room (OR 1.65 1.59-1.71) and first hospitalization lasting >30 days (OR, 1.58 1.49-1.68). In contrast, no socioeconomic characteristic was associated with early mortality. CONCLUSION Almost 1 in 5 patients diagnosed with lung cancer in France died within 3 months post-diagnosis. Improving survival requires diagnosis at an earlier stage and better organization of diagnosis and specific care pathways.
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Affiliation(s)
| | | | | | - Camille Jung
- Centre de Recherche CliniqueCHI de CréteilCréteilFrance
| | | | | | | | | | - Andrea Lazatti
- Département de Chirurgie DigestiveCHI de CréteilCréteilFrance
| | - Christos Chouaïd
- Département de PneumologieCHI de CréteilCréteilFrance,UPEC, Inserm U955, IMRBCréteilFrance
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Garinet S, Wang P, Mansuet-Lupo A, Fournel L, Wislez M, Blons H. Updated Prognostic Factors in Localized NSCLC. Cancers (Basel) 2022; 14:cancers14061400. [PMID: 35326552 PMCID: PMC8945995 DOI: 10.3390/cancers14061400] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/06/2022] [Accepted: 03/08/2022] [Indexed: 12/25/2022] Open
Abstract
Lung cancer is the most common cause of cancer mortality worldwide, and non-small cell lung cancer (NSCLC) represents 80% of lung cancer subtypes. Patients with localized non-small cell lung cancer may be considered for upfront surgical treatment. However, the overall 5-year survival rate is 59%. To improve survival, adjuvant chemotherapy (ACT) was largely explored and showed an overall benefit of survival at 5 years < 7%. The evaluation of recurrence risk and subsequent need for ACT is only based on tumor stage (TNM classification); however, more than 25% of patients with stage IA/B tumors will relapse. Recently, adjuvant targeted therapy has been approved for EGFR-mutated resected NSCLC and trials are evaluating other targeted therapies and immunotherapies in adjuvant settings. Costs, treatment duration, emergence of resistant clones and side effects stress the need for a better selection of patients. The identification and validation of prognostic and theranostic markers to better stratify patients who could benefit from adjuvant therapies are needed. In this review, we report current validated clinical, pathological and molecular prognosis biomarkers that influence outcome in resected NSCLC, and we also describe molecular biomarkers under evaluation that could be available in daily practice to drive ACT in resected NSCLC.
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Affiliation(s)
- Simon Garinet
- Pharmacogenomics and Molecular Oncology Unit, Biochemistry Department, Assistance Publique—Hopitaux de Paris, Hôpital Européen Georges Pompidou, 75015 Paris, France;
- Centre de Recherche des Cordeliers, INSERM UMRS-1138, Sorbonne Université, Université de Paris, 75006 Paris, France
| | - Pascal Wang
- Oncology Thoracic Unit, Pulmonology Department, Assistance Publique—Hopitaux de Paris, Hôpital Cochin, 75014 Paris, France; (P.W.); (M.W.)
| | - Audrey Mansuet-Lupo
- Pathology Department, Assistance Publique—Hopitaux de Paris, Hôpital Cochin, 75014 Paris, France;
| | - Ludovic Fournel
- Thoracic Surgery Department, Assistance Publique—Hopitaux de Paris, Hôpital Cochin, 75014 Paris, France;
| | - Marie Wislez
- Oncology Thoracic Unit, Pulmonology Department, Assistance Publique—Hopitaux de Paris, Hôpital Cochin, 75014 Paris, France; (P.W.); (M.W.)
| | - Hélène Blons
- Pharmacogenomics and Molecular Oncology Unit, Biochemistry Department, Assistance Publique—Hopitaux de Paris, Hôpital Européen Georges Pompidou, 75015 Paris, France;
- Centre de Recherche des Cordeliers, INSERM UMRS-1138, Sorbonne Université, Université de Paris, 75006 Paris, France
- Correspondence:
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Syed YA, Stokes W, Rupji M, Liu Y, Khullar O, Sebastian N, Higgins K, Bradley JD, Curran WJ, Ramalingam S, Taylor J, Sancheti M, Fernandez F, Moghanaki D. Surgical Outcomes for Early Stage Non-small Cell Lung Cancer at Facilities With Stereotactic Body Radiation Therapy Programs. Chest 2022; 161:833-844. [PMID: 34785235 PMCID: PMC8941602 DOI: 10.1016/j.chest.2021.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/26/2021] [Accepted: 11/07/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Patients undergoing surgery for early stage non-small cell lung cancer (NSCLC) may be at high risk for postoperative mortality. Access to stereotactic body radiation therapy (SBRT) may facilitate more appropriate patient selection for surgery. RESEARCH QUESTION Is postoperative mortality associated with early stage NSCLC lower at facilities with higher use of SBRT? STUDY DESIGN AND METHODS Patients with early stage NSCLC reported to the National Cancer Database between 2004 and 2015 were included. Use of SBRT was defined by each facility's SBRT experience (in years) and SBRT to surgery volume ratios. Multivariate logistic regression was used to test for the associations between SBRT use and postoperative mortality. RESULTS The study cohort consisted of 202,542 patients who underwent surgical resection of cT1-T2N0M0 NSCLC tumors. The 90-day postoperative mortality rate declined during the study period from 4.6% to 2.6% (P < .001), the proportion of facilities that used SBRT increased from 4.6% to 77.5% (P < .001), and the proportion of patients treated with SBRT increased from 0.7% to 15.4% (P < .001). On multivariate analysis, lower 90-day postoperative mortality rates were observed at facilities with > 6 years of SBRT experience (OR, 0.84; 95% CI, 0.76-0.94; P = .003) and SBRT to surgery volume ratios of more than 17% (OR, 0.85; 95% CI, 0.79-0.92; P < .001). Ninety-day mortality also was associated with surgical volume, region, year, age, sex, and race, among other covariates. Interaction testing between these covariates showed negative results. INTERPRETATION Patients who underwent resection for early stage NSCLC at facilities with higher SBRT use showed lower rates of postoperative mortality. These findings suggest that the availability and use of SBRT may improve the selection of patients for surgery who are predicted to be at high risk of postoperative mortality.
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Affiliation(s)
- Yusef A. Syed
- Department of Radiation Oncology, Emory University Winship Cancer Institute, Atlanta, GA
| | - William Stokes
- Department of Radiation Oncology, Emory University Winship Cancer Institute, Atlanta, GA
| | - Manali Rupji
- Biostatistics Shared Resource, Emory University Winship Cancer Institute, Atlanta, GA
| | - Yuan Liu
- Biostatistics Shared Resource, Emory University Winship Cancer Institute, Atlanta, GA
| | - Onkar Khullar
- Department of Surgery, Emory University, Atlanta, GA
| | - Nikhil Sebastian
- Department of Radiation Oncology, Emory University Winship Cancer Institute, Atlanta, GA
| | - Kristin Higgins
- Department of Radiation Oncology, Emory University Winship Cancer Institute, Atlanta, GA
| | - Jeffrey D. Bradley
- Department of Radiation Oncology, Emory University Winship Cancer Institute, Atlanta, GA
| | - Walter J. Curran
- Department of Radiation Oncology, Emory University Winship Cancer Institute, Atlanta, GA
| | - Suresh Ramalingam
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA
| | - James Taylor
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA
| | - Manu Sancheti
- Department of Surgery, Emory University, Atlanta, GA
| | | | - Drew Moghanaki
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA.
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Labiner HE, Hyer M, Cloyd JM, Tsilimigras DI, Dalmacy D, Paro A, Pawlik TM. Social Vulnerability Subtheme Analysis Improves Perioperative Risk Stratification in Hepatopancreatic Surgery. J Gastrointest Surg 2022; 26:1171-1177. [PMID: 35023035 PMCID: PMC8754363 DOI: 10.1007/s11605-022-05245-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/01/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND There has been increased interest in understanding how social determinants of health (SDH) may affect care both in the medical and surgical setting. We sought to define the impact of various aspects of social vulnerability on the ability of patients to achieve a "textbook outcome" (TO) following hepatopancreatic surgery. METHODS Medicare beneficiaries who underwent hepatopancreatic resection between 2013 and 2017 were identified using the Medicare database. Social vulnerability was defined using the Centers for Disease Control Social Vulnerability Index (SVI), which is comprised of four subthemes: socioeconomic (SE), household composition and disability (HCD), minority status and language (MSL), and housing type and transportation (HTT). TO was defined as the composite endpoint: absence of 90-day mortality or readmission, absence of an extended length of stay (LOS), and no complications during the index admission. Cluster analysis was used to identify vulnerability cohorts, and multivariable logistic regression was utilized to assess the impact of these SVI subthemes on the likelihood to achieve a textbook outcome. RESULTS Among 37,707 Medicare beneficiaries, 64.9% (n = 24,462) of patients underwent pancreatic resection while 35.1% (n = 13,245) underwent hepatic resection. Median patient age was 72 years (IQR: 68-77), just over one-half were male (51.9%; n = 19,558), and the median CCI was 3 (IQR: 2-8). Cluster analysis revealed five distinct SVI profiles with wide variability in the distribution of SVI subthemes, ranging from 15 (profile 1 IQR: 7-26) to 83 (profile 5 IQR: 66-93). The five profiles were grouped into 3 categories based on median composite SVI: "low vulnerability" (profile 1), "average vulnerability" (profiles 2 and 3), or "high vulnerability" (profiles 4 and 5). The rate of TO ranged from 44.6% in profile 5 (n = 4022) to 49.2% in profile 1 (n = 4836). Multivariable analyses comparing patients categorized into the two average SVI profiles revealed that despite having similar composite SVI scores, the risk of adverse postoperative outcomes was not similar. Specifically, patients from profile 5 had lower odds of achieving a TO (OR 0.89, 95%CI: 0.83-0.95) and higher odds of 90-day mortality (OR 1.29, 95%CI: 1.15-1.44) versus patients in profile 4. CONCLUSION Distinct profiles of SVI subtheme characteristics were independently associated with postoperative outcomes among Medicare beneficiaries undergoing HP surgery, even among patients with similar overall composite SVI scores.
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Affiliation(s)
- Hanna E. Labiner
- The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Columbus, OH USA
| | - Madison Hyer
- The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Columbus, OH USA
| | - Jordan M. Cloyd
- The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Columbus, OH USA
| | - Diamantis I. Tsilimigras
- The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Columbus, OH USA
| | - Djhenne Dalmacy
- The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Columbus, OH USA
| | - Alessandro Paro
- The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Columbus, OH USA
| | - Timothy M. Pawlik
- The Ohio State University Wexner Medical Center, The James Comprehensive Cancer Center, Columbus, OH USA
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10
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Abstract
Social disparities in lung cancer diagnosis, treatment, and survival have been studied using national databases, statewide registries, and institution-level data. Some disparities emerge consistently, such as lower adherence to treatment guidelines and worse survival by race and socioeconomic status, whereas other disparities are less well studied. A critical appraisal of current data is essential to increasing equity in lung cancer care.
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Affiliation(s)
- Irmina Elliott
- Department of Cardiothoracic Surgery, Stanford University, 300 Pasteur Dr Falk Cardiovascular Research Building, Stanford, CA 94305-5407, USA
| | - Cayo Gonzalez
- Department of Cardiothoracic Surgery, Stanford University, 300 Pasteur Dr Falk Cardiovascular Research Building, Stanford, CA 94305-5407, USA
| | - Leah Backhus
- Department of Cardiothoracic Surgery, Stanford University, 300 Pasteur Dr Falk Cardiovascular Research Building, Stanford, CA 94305-5407, USA
| | - Natalie Lui
- Department of Cardiothoracic Surgery, Stanford University, 300 Pasteur Dr Falk Cardiovascular Research Building, Stanford, CA 94305-5407, USA.
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11
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Underwood PW, Riner AN, Neal D, Cameron ME, Yakovenko A, Reddy S, Rose JB, Hughes SJ, Trevino JG. It's more than just cancer biology: Health disparities in patients with pancreatic neuroendocrine tumors. J Surg Oncol 2021; 124:1390-1401. [PMID: 34499741 DOI: 10.1002/jso.26667] [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: 03/09/2021] [Revised: 06/05/2021] [Accepted: 08/29/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVES Pancreatic neuroendocrine tumors (PNETs) represent a rare form of pancreatic cancer. Racial/ethnic disparities have been documented in pancreatic ductal adenocarcinoma, but health disparities have not been well described in patients with PNETs. METHODS A retrospective review of patients with PNETs in the National Cancer Database was performed for 2004-2014. Approximately 16 605 patients with PNETs and available vital status were identified. Survival was compared by race/ethnicity and socioeconomic status using Kaplan-Meier methods and Cox regression. RESULTS There were no significant differences in survival between Non-Hispanic, White; Hispanic, White; or Non-Hispanic, Black patients on univariate analysis. Kaplan-Meier analysis showed that patients from communities with lower median household income and education level had worse survival (p < 0.001). Patients age less than 65 without insurance, similarly, had worse survival (p < 0.001). Multivariable modeling found no association between race/ethnicity and risk of mortality (p = 0.37). Lower median household income and lower education level were associated with increased mortality (p < 0.001). CONCLUSIONS Unlike most other malignancies, race/ethnicity is not associated with survival differences in patients with PNETs. Patients with lower socioeconomic status had worse survival. The presence of identifiable health disparities in patients with PNETs represents a target for intervention and opportunity to improve survival in patients with this malignancy.
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Affiliation(s)
- Patrick W Underwood
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Andrea N Riner
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Dan Neal
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Miles E Cameron
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Anastasiya Yakovenko
- Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Sushanth Reddy
- Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - John Bart Rose
- Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - Steven J Hughes
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jose G Trevino
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA.,Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
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12
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Goussault H, Gendarme S, Assié JB, Bylicki O, Chouaïd C. Factors associated with early lung cancer mortality: a systematic review. Expert Rev Anticancer Ther 2021; 21:1125-1133. [PMID: 34121578 DOI: 10.1080/14737140.2021.1941888] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Despite recent therapeutic advances, lung cancer remains the primary cause of cancer deaths worldwide, and early lung mortality was poorly studied.Area covered: Early lung-cancer mortality reflects local therapy (surgery or radiotherapy) impact (localized forms), and metastatic disease evolution, comorbidities and healthcare-system accessibility. The definition of early lung cancer mortality is not consensual; thresholds range from 1 to 12 months post-diagnosis. This systematic review was undertaken to identify and analyze factors significantly associated with early lung cancer mortality. Age, male sex, non-adenocarcinoma histology, advanced stage at diagnosis and ECOG performance status are the main clinical factors of early lung cancer mortality. Active/ex-smoking also seems to favor early mortality, despite heterogeneous definitions of smoker status. For radio-chemotherapy treated locally advance disease, the early mortality rate increases according to tumor volume. Less well studied, socioeconomic characteristics (rurality and social deprivation index) yielded contradictory results, partially because definitions vary over studies. However, early lung cancer mortality is significantly higher for lower socioeconomic class patients.Expert opinion: Prospective, observational, general population studies are needed to better evaluate early lung-cancer mortality. International consensus concerning the patient-, disease- or healthcare system-linked factors of interest to be collected would facilitate comparisons among countries.
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Affiliation(s)
- Helene Goussault
- Respiratory Medicine, Centre Hospitalier Intercommunal De Créteil, Creteil, France.,INSERM U955, Creteil, Île-de-france, France
| | - Sebastien Gendarme
- Respiratory Medicine, Centre Hospitalier Intercommunal De Créteil, Creteil, France.,INSERM U955, Creteil, Île-de-france, France
| | - Jean Baptiste Assié
- Respiratory Medicine, Centre Hospitalier Intercommunal De Créteil, Creteil, France.,Centre De Recherche Des Cordeliers, Paris, Île-de-france, France
| | - Olivier Bylicki
- Hopital D'instruction Des Armées De Saint-Anne, Toulon, France
| | - Christos Chouaïd
- Respiratory Medicine, Centre Hospitalier Intercommunal De Créteil, Creteil, France.,INSERM U955, Creteil, Île-de-france, France
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13
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Bonner SN, Wakeam E. The volume-outcome relationship in lung cancer surgery: The impact of the social determinants of health care delivery. J Thorac Cardiovasc Surg 2021; 163:1933-1937. [PMID: 33994006 DOI: 10.1016/j.jtcvs.2021.02.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/13/2021] [Accepted: 02/24/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Sidra N Bonner
- Department of Surgery, University of Michigan, Ann Arbor, Mich
| | - Elliot Wakeam
- Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Mich; Center for Healthcare Outcomes and Policy, Ann Arbor, Mich.
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14
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de La Motte Watson S, Puxty K, Moran D, Morrison DS, Sloan B, Buggy D, Shelley B. Association Between Anesthetic Dose and Technique and Oncologic Outcomes After Surgical Resection of Non-Small Cell Lung Cancer. J Cardiothorac Vasc Anesth 2021; 35:3265-3274. [PMID: 33934988 DOI: 10.1053/j.jvca.2021.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/05/2021] [Accepted: 03/20/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Because of the biologic effects of volatile anesthetics on the immune system and cancer cells, it has been hypothesized that their use during non-small cell lung cancer (NSCLC) surgery may negatively affect cancer outcomes compared with total intravenous anesthesia (TIVA) with propofol. The present study evaluated the relationship between anesthetic technique and dose and oncologic outcome in NSCLC surgery. DESIGN Retrospective cohort study. SETTING Surgical records collated from a single, tertiary care hospital and combined with the Scottish Cancer Registry and continuously recorded electronic anesthetic data. PARTICIPANTS Patients undergoing elective lung resection for NSCLC between January 2010 and December 2014. INTERVENTIONS The cohort was divided into patients receiving TIVA only and patients exposed to volatile anesthetics. MEASUREMENTS AND MAIN RESULTS Final analysis included 746 patients (342 received TIVA and 404 volatile anesthetic). Kaplan-Meier survival curves with log-rank testing were drawn for cancer-specific and overall survival. No significant differences were demonstrated for either cancer-specific (p = 0.802) or overall survival (p = 0.736). Factors influencing survival were analyzed using Cox proportional hazards modeling. Anesthetic type was not a significant predictor for cancer-specific or overall survival in univariate or multivariate Cox analysis. Volatile anesthetic exposure was quantified using area under the end-tidal expired anesthetic agent versus time curves. This was not significantly associated with cancer-specific survival on univariate (p = 0.357) or multivariate (p = 0.673) modeling. CONCLUSIONS No significant relationship was demonstrated between anesthetic technique and NSCLC survival. Whether a causal relationship exists between anesthetic technique during NSCLC surgery and oncologic outcome warrants definitive investigation in a prospective, randomized trial.
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Affiliation(s)
| | - Kathryn Puxty
- University of Glasgow, Glasgow, UK; Glasgow Royal Infirmary, Glasgow, UK
| | | | - David S Morrison
- University of Glasgow, Glasgow, UK; Scottish Cancer Registry, Public Health Scotland, Edinburgh, UK
| | | | - Donal Buggy
- Mater University Hospital, School of Medicine, University College Dublin, Dublin, Ireland; Outcomes Research, Cleveland Clinic, Cleveland, OH
| | - Ben Shelley
- University of Glasgow, Glasgow, UK; Golden Jubilee National Hospital, Clydebank, UK.
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15
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Bliton J, Parides M, Muscarella P, McAuliffe JC, Papalezova K, In H. Clinical Stage of Cancer Affects Perioperative Mortality for Gastrointestinal Cancer Surgeries. J Surg Res 2020; 260:1-9. [PMID: 33310353 DOI: 10.1016/j.jss.2020.11.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/07/2020] [Accepted: 11/01/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The impact of the stage of cancer on perioperative mortality remains obscure. The purpose of this study was to investigate whether cancer stage influences 30-d mortality for gastric, pancreatic, and colorectal cancers. METHODS Data were collected from the National Cancer Database for patients undergoing resections for cancers of the stomach, pancreas, colon, or rectum between 2004 and 2015. The main analysis was conducted among patients with cancer stages 1-3. A sensitivity analysis also included cancer stage 4. Descriptive statistics were used to compare the patients' baseline characteristics. Generalized linear mixed models were used to evaluate the relationship between stage and 30-d mortality, controlling for other disease-, patient- and hospital-level factors. Pseudo R2 statistics (%Δ pseudo R2) were used to quantify the relative explanatory capacity of the variables to the model for 30-d mortality. All analyses were performed using SAS 9.4. RESULTS The cohort included 24,468, 28,078, 176,285, and 64,947 patients with stomach, pancreas, colon, and rectal cancers, respectively. After adjusting for other variables, 30-d mortality was different by stage for all cancer types examined. The factor most strongly associated with 30-d mortality was age (%Δ pseudo R2 range 14%-39%). The prognostic impact of cancer stage (Stages 1, 2, or 3) on 30-d mortality was comparable to that of the Charlson comorbidity index. CONCLUSIONS Cancer stage contributes to explaining differences observed in short-term mortality for gastrointestinal cancers. Short-term mortality models would benefit by including more granular cancer stage, beyond disseminated status alone.
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Affiliation(s)
- John Bliton
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Michael Parides
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Peter Muscarella
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - John C McAuliffe
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Katia Papalezova
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
| | - Haejin In
- Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; Department of Epidemiology and Population Health, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
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16
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Melvan JN, Khullar O, Vemulapalli S, Kosinski AS, Pickens A, Force SD, Zhang S, Sancheti MS. Community Size and Lung Cancer Resection Outcomes: Studying The Society of Thoracic Surgeons Database. Ann Thorac Surg 2020; 112:1076-1082. [PMID: 33189672 DOI: 10.1016/j.athoracsur.2020.08.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Socioeconomic factors play key roles in surgical outcomes. Socioeconomic data within The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTSD) are limited. Therefore, we utilized community size as a surrogate to understand socioeconomic differences in lung cancer resection outcomes. METHODS We retrospectively reviewed all lung cancer resections from January 2012 to January 2017 in the STS GTSD. This captured 68,722 patients from 286 centers nationwide. We then linked patient zip codes with 2013 Rural-Urban Continuum Codes to understand the association between community size and postoperative outcomes. Demographic and clinical variables were evaluated for relationships with 30-day mortality, major morbidity, and readmission. RESULTS Zip codes were included in 47.2% of patients. Zip-coded patients were older, were more comorbid, had less advanced disease, and were more commonly treated with minimally invasive approaches than were those without zip code classification. For geocoded patients, multivariable analyses demonstrated that sex, insurance payor, and hospital region were associated with all 3 major endpoints. Community size, based on Rural-Urban Continuum Codes coding, was not associated with any primary endpoint. Invasive mediastinal staging was related to morbidity, greater pathological stage predicted mortality, and worsened clinical stage was associated with readmission. More invasive surgery and greater extent of lung resection were associated with all primary endpoints. CONCLUSIONS Incomplete data capture can promote selection bias within the STS GTSD and skew outcomes reporting. Moreover, community size is an insufficient surrogate, compared with sex, insurance payor, hospital region, for understanding socioeconomic differences in lung cancer resection outcomes.
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Affiliation(s)
- John Nicholas Melvan
- Division of Cardiothoracic Surgery, Holy Cross Hospital, Fort Lauderdale, Florida; Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
| | - Onkar Khullar
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Andrzej S Kosinski
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Allan Pickens
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Seth D Force
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Shuaiqi Zhang
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Manu S Sancheti
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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17
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18
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Mehaffey JH, Hawkins RB, Charles EJ, Turrentine FE, Kaplan B, Fogel S, Harris C, Reines D, Posadas J, Ailawadi G, Hanks JB, Hallowell PT, Jones RS. Community level socioeconomic status association with surgical outcomes and resource utilisation in a regional cohort: a prospective registry analysis. BMJ Qual Saf 2019; 29:232-237. [PMID: 31540969 DOI: 10.1136/bmjqs-2019-009800] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/12/2019] [Accepted: 09/15/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Socioeconomic status affects surgical outcomes, however these factors are not included in clinical quality improvement data and risk models. We performed a prospective registry analysis to determine if the Distressed Communities Index (DCI), a composite socioeconomic ranking by zip code, could predict risk-adjusted surgical outcomes and resource utilisation. METHODS All patients undergoing surgery (n=44,451) in a regional quality improvement database (American College of Surgeons-National Surgical Quality Improvement Program ACS-NSQIP) were paired with DCI, ranging from 0-100 (low to high distress) and accounting for unemployment, education level, poverty rate, median income, business growth and housing vacancies. The top quartile of distress was compared to the remainder of the cohort and a mixed effects modeling evaluated ACS-NSQIP risk-adjusted association between DCI and the primary outcomes of surgical complications and resource utilisation. RESULTS A total of 9369 (21.1%) patients came from severely distressed communities (DCI >75), who had higher rates of most medical comorbidities as well as transfer status (8.4% vs 4.8%, p<0.0001) resulting in higher ACS-NSQIP predicted risk of any complication (8.0% vs 7.1%, p<0.0001). Patients from severely distressed communities had increased 30-day mortality (1.8% vs 1.4%, p=0.01), postoperative complications (9.8% vs 8.5%, p<0.0001), hospital readmission (7.7 vs 6.8, p<0.0001) and resource utilisation. DCI was independently associated with postoperative complications (OR 1.07, 95% CI 1.04 to 1.10, p<0.0001) as well as resource utilisation after adjusting for ACS-NSQIP predicted risk CONCLUSION: Increasing Distressed Communities Index is associated with increased postoperative complications and resource utilisation even after ACS-NSQIP risk adjustment. These findings demonstrate a disparity in surgical outcomes based on community level socioeconomic factors, highlighting the continued need for public health innovation and policy initiatives.
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Affiliation(s)
| | | | - Eric J Charles
- Surgery, University of Virginia, Charlottesville, Virginia, USA
| | | | - Brian Kaplan
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sandy Fogel
- Department of Surgery, Carilion Clinic, Roanoke, Virginia, USA
| | - Charles Harris
- Department of Surgery, Carilion Clinic, Roanoke, Virginia, USA
| | - David Reines
- Department of Surgery, Inova Mount Vernon Hospital, Alexandria, Virginia, USA
| | - Jorge Posadas
- Department of Surgery, Winchester Medical Center, Winchester, Virginia, USA
| | - Gorav Ailawadi
- Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - John B Hanks
- Surgery, University of Virginia, Charlottesville, Virginia, USA
| | | | - R Scott Jones
- Surgery, University of Virginia, Charlottesville, Virginia, USA
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19
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Finke I, Behrens G, Weisser L, Brenner H, Jansen L. Socioeconomic Differences and Lung Cancer Survival-Systematic Review and Meta-Analysis. Front Oncol 2018; 8:536. [PMID: 30542641 PMCID: PMC6277796 DOI: 10.3389/fonc.2018.00536] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/31/2018] [Indexed: 12/14/2022] Open
Abstract
Background: The impact of socioeconomic differences on cancer survival has been investigated for several cancer types showing lower cancer survival in patients from lower socioeconomic groups. However, little is known about the relation between the strength of association and the level of adjustment and level of aggregation of the socioeconomic status measure. Here, we conduct the first systematic review and meta-analysis on the association of individual and area-based measures of socioeconomic status with lung cancer survival. Methods: In accordance with PRISMA guidelines, we searched for studies on socioeconomic differences in lung cancer survival in four electronic databases. A study was included if it reported a measure of survival in relation to education, income, occupation, or composite measures (indices). If possible, meta-analyses were conducted for studies reporting on individual and area-based socioeconomic measures. Results: We included 94 studies in the review, of which 23 measured socioeconomic status on an individual level and 71 on an area-based level. Seventeen studies were eligible to be included in the meta-analyses. The meta-analyses revealed a poorer prognosis for patients with low individual income (pooled hazard ratio: 1.13, 95 % confidence interval: 1.08–1.19, reference: high income), but not for individual education. Group comparisons for hazard ratios of area-based studies indicated a poorer prognosis for lower socioeconomic groups, irrespective of the socioeconomic measure. In most studies, reported 1-, 3-, and 5-year survival rates across socioeconomic status groups showed decreasing rates with decreasing socioeconomic status for both individual and area-based measures. We cannot confirm a consistent relationship between level of aggregation and effect size, however, comparability across studies was hampered by heterogeneous reporting of socioeconomic status and survival measures. Only eight studies considered smoking status in the analysis. Conclusions: Our findings suggest a weak positive association between individual income and lung cancer survival. Studies reporting on socioeconomic differences in lung cancer survival should consider including smoking status of the patients in their analysis and to stratify by relevant prognostic factors to further explore the reasons for socioeconomic differences. A common definition for socioeconomic status measures is desirable to further enhance comparisons between nations and across different levels of aggregation.
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Affiliation(s)
- Isabelle Finke
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Gundula Behrens
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Linda Weisser
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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20
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Salako O, Okediji PT, Habeebu MY, Fatiregun OA, Awofeso OM, Okunade KS, Odeniyi IA, Salawu KO, Oboh EO. The pattern of comorbidities in cancer patients in Lagos, South-Western Nigeria. Ecancermedicalscience 2018; 12:843. [PMID: 30034520 PMCID: PMC6027981 DOI: 10.3332/ecancer.2018.843] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Indexed: 12/21/2022] Open
Abstract
Purpose Comorbidities have been indicated to influence cancer care and outcome, with strong associations between the presence of comorbidities and patient survival. The objective of this study is to determine the magnitude and pattern of comorbidities in Nigerian cancer populations, and demonstrate the use of comorbidity indices in predicting mortality/survival rates of cancer patients. Methods Using a retrospective study design, data were extracted from hospital reports of patients presenting for oncology care between January 2015 and December 2016 at two tertiary health facilities in Lagos, Nigeria. Patient comorbidities were ranked and weighted using the Charlson comorbidity index (CCI). Results The mean age for the 848 cancer patients identified was 53.9 ± 13.6 years, with 657 (77.5%) females and 191 (22.5%) males. Breast (50.1%), cervical (11.1%) and colorectal (6.3%) cancers occurred most frequently. Comorbidities were present in 228 (26.9%) patients, with the most common being hypertension (20.4%), diabetes (6.7%) and peptic ulcer disease (2.1%). Hypertension-augmented CCI scores were 0 (15.6%), 1–3 (62.1%), 4–6 (21.7%) and ≥7 (0.6%). The mean CCI scores of patients ≤50 years (0.8 ± 0.9) and ≥51 years (3.3 ± 1.2) were significantly different (p < 0.05). Patients with lower mean CCI scores were more likely to receive chemotherapy (2.2 ± 1.6 versus 2.5 ± 1.9; p < 0.05) and/or surgery (2.1 ± 1.5 versus 2.4 ± 1.7; p < 0.05). Conclusion Comorbidities occur significantly in Nigerian cancer patients and influence the prognosis, treatment outcome and survival rates of these patients. There is a need to routinely evaluate cancer patients for comorbidities with the aim of instituting appropriate multidisciplinary management measures where necessary.
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Affiliation(s)
- Omolola Salako
- Department of Radiotherapy, Lagos University Teaching Hospital, Idi-Araba, Lagos 100254, Nigeria
| | - Paul T Okediji
- Research and Development, Sebeccly Cancer Care, Yaba, Lagos 101212, Nigeria
| | - Muhammad Y Habeebu
- Department of Radiotherapy, Lagos University Teaching Hospital, Idi-Araba, Lagos 100254, Nigeria
| | - Omolara A Fatiregun
- Department of Radiotherapy, Lagos State University Teaching Hospital, Ikeja, Lagos 100254, Nigeria
| | - Opeyemi M Awofeso
- College of Medicine, University of Lagos, Akoka, Lagos 100254, Nigeria
| | - Kehinde S Okunade
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos 100254, Nigeria
| | - Ifedayo A Odeniyi
- Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos 100254, Nigeria
| | - Kahmil O Salawu
- Research and Development, Sebeccly Cancer Care, Yaba, Lagos 101212, Nigeria
| | - Evaristus O Oboh
- Department of Radiotherapy, University of Benin Teaching Hospital, Benin 300283, Nigeria
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21
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Treatment trends in early-stage lung cancer in the United States, 2004 to 2013: A time-trend analysis of the National Cancer Data Base. J Thorac Cardiovasc Surg 2018; 156:1233-1246.e1. [PMID: 30119287 DOI: 10.1016/j.jtcvs.2018.03.174] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 03/14/2018] [Accepted: 03/22/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The study objective was to evaluate trends in the use of surgical therapy for patients with early-stage (IA-IIA) non-small cell lung cancer when stereotactic ablative radiotherapy was introduced in the United States. METHODS Patients with clinical stage IA to IIA non-small cell lung cancer diagnosed from January 1, 2004, to December 31, 2013, were identified in the National Cancer Data Base. The Cochran-Armitage trend test was used to evaluate the change in the proportion of patients undergoing surgery over time. Logistic regression was used to identify the factors associated with receipt of surgery compared with radiation. RESULTS Of 200,404 eligible patients from 1235 hospitals, 79.8% (n = 159,943) underwent surgery. For all stages combined, the rate of surgery decreased from 83.9% in 2004 to 75.1% in 2013 (P < .0001), with the largest decrease seen in patients with stage IIA: stage IA 86.5% to 77.1% (P < .0001); stage IB 79.6% to 71.5% (P < .0001); and stage IIA 94.7% to 70.3% (P < .001). Patients were more likely to undergo surgery if they were younger and white, had higher income, or had private or Medicare insurance. CONCLUSIONS From 2004 to 2013, there was an overall decrease in the use of surgical therapy for lung cancer in early-stage disease. Because resection remains the standard of care for most patients with early-stage disease, these data suggest a potentially significant quality gap in the treatment of patients with non-small cell lung cancer.
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22
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Zhang R, Kyriss T, Dippon J, Ciupa S, Boedeker E, Friedel G. Impact of comorbidity burden on morbidity following thoracoscopic lobectomy: a propensity-matched analysis. J Thorac Dis 2018; 10:1806-1814. [PMID: 29707335 DOI: 10.21037/jtd.2018.02.62] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Given the positive effect of a thoracoscopic approach on improving postoperative outcomes, it is reasonable to speculate whether an increased comorbidity burden is related to higher morbidity following thoracoscopic lobectomy. We sought to evaluate the impact of comorbidity burden on adverse postoperative outcomes in this patient population. Methods A retrospective review of our institutional database included 512 patients undergoing thoracoscopic lobectomy for early-stage non-small cell lung cancer (NSCLC) from 2009 through 2016. Comorbidity burden was assessed by the Charlson comorbidity index (CCI) and classified as high (CCI ≥3) or low (CCI <3) grade. Propensity score matching and random effects model were performed. Results Patients included 228 women and 284 men with a median age of 67 years. High and low comorbidity burdens were found in 193 and 319 patients, respectively. The postoperative mortality, pulmonary and cardiovascular complication rates and overall morbidity in patients with high comorbidity burden were comparable to those with low comorbidity burden (1.6% vs. 0.6%, 9.3% vs. 8.5%, 6.2% vs. 6.0%, 24.4% vs. 22.9%, respectively). Similar results were seen after propensity score matching, which balanced differences in demographics and preoperative characteristics between the comorbidity groups. On the analyses of propensity-matched data using generalized linear mixed model, a high comorbidity burden was not related to greater postoperative complication rates. Conclusions Our results suggest that thoracoscopic lobectomy can be performed with low mortality and reasonable morbidity in lung cancer patients presenting with multiple comorbid diseases. The presence of a high comorbidity burden measured by CCI does not have a perceptible impact on adverse postoperative outcomes following thoracoscopic lobectomy.
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Affiliation(s)
- Ruoyu Zhang
- Department of Thoracic Surgery, Center for Pneumology and Thoracic Surgery, Chest Hospital Schillerhoehe, Robert-Bosch-Krankenhaus, Teaching Hospital of the University of Tuebingen, Stuttgart, Germany
| | - Thomas Kyriss
- Department of Thoracic Surgery, Center for Pneumology and Thoracic Surgery, Chest Hospital Schillerhoehe, Robert-Bosch-Krankenhaus, Teaching Hospital of the University of Tuebingen, Stuttgart, Germany
| | - Jürgen Dippon
- Institute of Stochastics and Applications, University Stuttgart, Stuttgart, Germany
| | - Sebastian Ciupa
- Department of Anaesthesia, Chest Hospital Schillerhoehe, Robert-Bosch-Krankenhaus, Teaching hospital of the University of Tuebingen, Stuttgart, Germany
| | - Enole Boedeker
- Department of Thoracic Surgery, Center for Pneumology and Thoracic Surgery, Chest Hospital Schillerhoehe, Robert-Bosch-Krankenhaus, Teaching Hospital of the University of Tuebingen, Stuttgart, Germany
| | - Godehard Friedel
- Department of Thoracic Surgery, Center for Pneumology and Thoracic Surgery, Chest Hospital Schillerhoehe, Robert-Bosch-Krankenhaus, Teaching Hospital of the University of Tuebingen, Stuttgart, Germany
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Hajibandeh S, Hajibandeh S, Deering R, McEleney D, Guirguis J, Dix S, Sreh A, Toner E, El Muntasar A, Kausar A, Sheikh G, OShea D, Shafiq A, Kelly A, Khan A, Arumugam D, Evans A. Accuracy of co-morbidity data in patients undergoing abdominal wall hernia repair: a retrospective study. Hernia 2017; 22:243-248. [PMID: 29243213 DOI: 10.1007/s10029-017-1713-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 12/09/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To determine the baseline accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of routinely collected co-morbidity data in patients undergoing abdominal wall hernia repair. METHODS All patients aged > 18 who underwent umbilical, para-umbilical, inguinal or incisional hernia repair between 1 January 2015 and 1 November 2016 were identified. All parts of the clinical notes were searched for co-morbidities by two authors independently. The following co-morbidities were considered: hypertension, ischaemic heart disease (IHD), diabetes, asthma, chronic obstructive pulmonary disease (COPD), cerebrovascular disease (CVD), chronic kidney disease (CKD), hypercholesterolemia, obesity and smoking. The co-morbidities data from clinical notes were compared with corresponding data in hospital episode statistics (HES) database to calculate accuracy, sensitivity, specificity, PPV and NPV of HES codes for co-morbidities. To assess the agreement between clinical notes and HES data, we also calculated Cohen's Kappa index value as a more robust measure of agreement. RESULTS Overall, 346 patients comprising 3460 co-morbidity codes were included in the study. The overall accuracy of HES codes for all co-morbidities was 77% (Kappa: 0.13). When calculated separately for each co-morbidity, the accuracy was 72% (Kappa: 0.113) for hypertension, 82% (Kappa: 0.232) for IHD, 85% (Kappa: 0.203) for diabetes, 86% (Kappa: 0.287) for asthma, 91% (Kappa: 0.339) for COPD, 92% (Kappa: 0.374) for CVD, 94% (Kappa: 0.424) for CKD, 74% (Kappa: 0.074) for hypercholesterolemia, 71% (Kappa: 0.66) for obesity and 24% (Kappa: 0.005) for smoking. The overall sensitivity, specificity, PPV and NPV of HES codes were 9, 100, 100, and 77%, respectively. The results were consistent when individual co-morbidities were analyzed separately. CONCLUSIONS Our results demonstrated that HES co-morbidity codes in patients undergoing abdominal wall hernia repair are specific with good positive predictive value; however, they have substandard accuracy, sensitivity, and negative predictive value. The presence of a relatively large number of false negative or missed cases in HES database explains our findings. Better documentation of co-morbidities in admission clerking proforma may help to improve the quality of source documents for coders, which in turn may improve the accuracy of coding.
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Affiliation(s)
- S Hajibandeh
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK.
- Department of General Surgery, Salford Royal Foundation Trust, Salford, UK.
| | - S Hajibandeh
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
- Department of General Surgery, North Manchester General Hospital, Manchester, UK
| | - R Deering
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - D McEleney
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - J Guirguis
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - S Dix
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - A Sreh
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - E Toner
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - A El Muntasar
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - A Kausar
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - G Sheikh
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - D OShea
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - A Shafiq
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - A Kelly
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - A Khan
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - D Arumugam
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
| | - A Evans
- Department of General Surgery, Royal Blackburn Hospital, Haslingden Rd, Blackburn, UK
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Hinchcliff E, Melamed A, Bregar A, Diver E, Clemmer J, Del Carmen M, Schorge JO, Alejandro Rauh-Hain J. Factors associated with delivery of neoadjuvant chemotherapy in women with advanced stage ovarian cancer. Gynecol Oncol 2017; 148:168-173. [PMID: 29128105 DOI: 10.1016/j.ygyno.2017.10.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 02/01/2023]
Abstract
PURPOSE To identify clinical and non-clinical factors associated with utilization of primary cytoreductive surgery (PCS) or neoadjuvant chemotherapy (NACT) in women with advanced stage epithelial ovarian cancer (EOC). METHODS Using the National Cancer Database, we identified women with stage IIIC and IV EOC diagnosed from 2012 to 2014. The primary outcome was receipt of NACT, defined in the primary analysis as utilization of chemotherapy as the first cancer-directed therapy, irrespective of whether interval surgery was performed. Univariable and multivariable associations between clinical and non-clinical factors and receipt of NACT were investigated using mixed-effect logistic regression models. A secondary analysis excluded women who received primary chemotherapy but did not receive interval cytoreductive surgery. RESULTS Among 17,302 eligible women, 10,948 (63.3%) underwent PCS and 6354 (36.7%) received NACT. Older age, stage IV disease, high-grade, and serous histology were associated with receipt of NACT in univariate (p<0.001) and multivariable analyses (p<0.001). Analysis of non-clinical factors revealed that residency in the Northeast region and receipt of treatment closer to home were associated with NACT in univariate (p<0.05) but not multivariable analysis (p>0.05). In multivariable analysis, African-American race/ethnicity (p=0.04), low-income level (p=0.02), treatment in high-volume centers (p<0.01), and insurance by Medicare or other government insurance (p<0.001) were associated with receipt of NACT. When women who received no surgery were excluded, all factors that were independent predictors of NACT in the main analysis remained significant, except for race/ethnicity. CONCLUSIONS Non-clinical factors were associated with the use of NACT at a magnitude similar to that of clinically relevant factors.
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Affiliation(s)
- Emily Hinchcliff
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA, United States.
| | - Alexander Melamed
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Amy Bregar
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Elisabeth Diver
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Joel Clemmer
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States
| | - Marcela Del Carmen
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - John O Schorge
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - J Alejandro Rauh-Hain
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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Shroyer AL, Quin JA, Grau-Sepulveda MV, Kosinski AS, Yerokun BA, Mitchell JD, Bilfinger TV. Geographic Variations in Lung Cancer Lobectomy Outcomes: The General Thoracic Surgery Database. Ann Thorac Surg 2017; 104:1650-1655. [DOI: 10.1016/j.athoracsur.2017.05.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 05/05/2017] [Accepted: 05/15/2017] [Indexed: 01/10/2023]
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26
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Taioli E, Liu B, Nicastri DG, Lieberman-Cribbin W, Leoncini E, Flores RM. Personal and hospital factors associated with limited surgical resection for lung cancer, in-hospital mortality and complications in New York State. J Surg Oncol 2017; 116:471-481. [PMID: 28570755 DOI: 10.1002/jso.24697] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/22/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Early stage lung cancer is generally treated with surgical resection. The objective of the study was to identify patient and hospital characteristics associated with the type of lung cancer surgical approach utilized in New York State (NYS), and to assess in-hospital adverse events. METHODS A total of 33 960 lung cancer patients who underwent limited resection (LR) or lobectomy (L) were selected from the NYS Statewide Planning and Research Cooperative System database (1995-2012). RESULTS LR patients were more likely to be older (adjusted odds ratio ORadj and [95% confidence interval]: 1.01 [1.01-1.02]), female (ORadj : 1.11 [1.06-1.16]), Black (ORadj : 1.17 [1.08-1.27]), with comorbidities (ORadj : 1.08 [1.03-1.14]), and treated in more recent years than L patients. Length of stay and complications were significantly less after LR than L (ORadj : 0.56 [0.53-0.58] and 0.65 [0.62-0.69]); in-hospital mortality was similar (ORadj : 0.93 [0.81-1.07]), and was positively associated with age and urgent/emergency admission, but inversely associated with female gender, private insurance, recent admission year, and surgery volume. CONCLUSIONS There was a growing trend toward LR, which was more likely to be performed in older patients with comorbidities. In-hospital outcomes were better after LR than L, and were affected by patient and hospital characteristics.
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Affiliation(s)
- Emanuela Taioli
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bian Liu
- Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel G Nicastri
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Wil Lieberman-Cribbin
- Department of Population Health Science and Policy and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Emanuele Leoncini
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Raja M Flores
- Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Chouaïd C, Debieuvre D, Durand-Zaleski I, Fernandes J, Scherpereel A, Westeel V, Blein C, Gaudin AF, Ozan N, Leblanc S, Vainchtock A, Chauvin P, Cotté FE, Souquet PJ. Survival inequalities in patients with lung cancer in France: A nationwide cohort study (the TERRITOIRE Study). PLoS One 2017; 12:e0182798. [PMID: 28841679 PMCID: PMC5571949 DOI: 10.1371/journal.pone.0182798] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 07/25/2017] [Indexed: 12/31/2022] Open
Abstract
The French healthcare system is a universal healthcare system with no financial barrier to access to health services and cancer drugs. The objective of the study is to investigate associations between, on the one hand, incidence and survival of patients diagnosed with lung cancer in France and, on the other, the socioeconomic deprivation and population density of their municipality of residence. A national, longitudinal analysis using data from the French National Hospital database crossed with the population density of the municipality and a social deprivation index based on census data aggregated at the municipality level. For lung cancer diagnosed at the metastatic stage, one-year and two-year survival was not associated with the population density of the municipality of residence. In contrast, mortality was higher for people living in very deprived, deprived and privileged areas compared to very privileged areas (hazard ratios at two years: 1.19 [1.13–1.25], 1.14 [1.08–1.20] and 1.10 [1.04–1.16] respectively). Similar associations are also observed in patients diagnosed with non-metastatic disease (hazard ratios at two years: 1.21 [1.13–1.30], 1.15 [1.08–1.23] and 1.10 [1.03–1.18] for people living in very deprived, deprived and privileged areas compared to very privileged areas). Despite a universal healthcare coverage, survival inequalities in patients with lung cancer can be observed in France with respect to certain socioeconomic indicators.
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Affiliation(s)
- Christos Chouaïd
- Department of Chest Medicine, Créteil University Hospital, Créteil, France
| | - Didier Debieuvre
- Department of Chest Medicine, Mulhouse University Hospital, Mulhouse, France
| | - Isabelle Durand-Zaleski
- URCEco Île-de-France, Hôtel-Dieu Hospital, Paris, France
- Department of Public Health, Henri-Mondor Hospital, Créteil, France
| | | | - Arnaud Scherpereel
- Pulmonary and Thoracic Oncology Department, Lille University Hospital, Lille, France
| | - Virginie Westeel
- Department of Chest Medicine, Jean Minjoz University Hospital, Besançon, France
| | | | - Anne-Françoise Gaudin
- Health Economics and Outcomes Research, Laboratoire Bristol-Myers Squibb, Rueil-Malmaison, France
| | - Nicolas Ozan
- Health Economics and Outcomes Research, Laboratoire Bristol-Myers Squibb, Rueil-Malmaison, France
| | | | | | - Pierre Chauvin
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Department of Social Epidemiology, Paris, France
| | - François-Emery Cotté
- Health Economics and Outcomes Research, Laboratoire Bristol-Myers Squibb, Rueil-Malmaison, France
- * E-mail:
| | - Pierre-Jean Souquet
- Department of Chest Medicine, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
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Miller BJ, Gao Y, Duchman KR. Socioeconomic measures influence survival in osteosarcoma: an analysis of the National Cancer Data Base. Cancer Epidemiol 2017; 49:112-117. [DOI: 10.1016/j.canep.2017.05.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/29/2017] [Accepted: 05/31/2017] [Indexed: 01/12/2023]
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Meert AP, Grigoriu B, Licker M, Van Schil PE, Berghmans T. Intensive care in thoracic oncology. Eur Respir J 2017; 49:49/5/1602189. [DOI: 10.1183/13993003.02189-2016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 02/06/2017] [Indexed: 01/21/2023]
Abstract
The admission of lung cancer patients to intensive care is related to postprocedural/postoperative care and medical complications due to cancer or its treatment, but is also related to acute organ failure not directly related to cancer.Despite careful preoperative risk management and the use of modern surgical and anaesthetic techniques, thoracic surgery remains associated with high morbidity, related to the extent of resection and specific comorbidities. Fast-tracking processes with timely recognition and treatment of complications favourably influence patient outcome. Postoperative preventive and therapeutic management has to be carefully planned in order to reduce postoperative morbidity and mortality.For patients with severe complications, intensive care unit (ICU) mortality rate ranges from 13% to 47%, and hospital mortality ranges from 24% to 65%. Common predictors of in-hospital mortality are severity scores, number of failing organs, general condition, respiratory distress and the need for mechanical ventilation or vasopressors. When considering long-term survival after discharge, cancer-related parameters retain their prognostic value.Thoracic surgeons, anesthesiologists, pneumologists, intensivists and oncologists need to develop close and confident partnerships aimed at implementing evidence-based patient care, securing clinical pathways for patient management while promoting education, research and innovation. The final decision on admitting a patient with lung to the ICU should be taken in close partnership between this medical team and the patient and his or her relatives.
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Crawford J, Wheatley-Price P, Feliciano JL. Treatment of Lung Cancer in Medically Compromised Patients. Am Soc Clin Oncol Educ Book 2017; 35:e484-91. [PMID: 27249757 DOI: 10.1200/edbk_158713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Outcomes for patients with lung cancer have been improved substantially through the integration of surgery, radiation, and systemic therapy for patients with early-stage disease. Meanwhile, advances in our understanding of molecular mechanisms have substantially advanced our treatment of patients with advanced lung cancer through the introduction of targeted therapies, immune approaches, improvements in chemotherapy, and better supportive care. However, the majority of these advances have occurred among patients with good functional status, normal organ function, and with the social and economic support systems to be able to benefit most from these treatments. The aim of this article is to bring greater attention to management of lung cancer in patients who are medically compromised, which remains a major barrier to care delivery. Impaired performance status is associated with poor outcomes and correlates with the high prevalence of cachexia among patients with advanced lung cancer. CT imaging is emerging as a research tool to quantify muscle loss in patients with cancer, and new therapeutics are on the horizon that may provide important adjunctive therapy in the future. The benefits of cancer therapy for patients with organ failure are poorly understood because of their exclusion from clinical trials. The availability of targeted therapy and immunotherapy may provide alternatives that may be easier to deliver in this population, but clinical trials of these new agents in this population are vital. Patients with lower socioeconomic status are disproportionately affected by lung cancer because of higher rates of tobacco addiction and the impact of socioeconomic status on delay in diagnosis, treatment, and outcomes. For all patients who are medically compromised with lung cancer, multidisciplinary approaches are particularly needed to evaluate these patients and to incorporate rapidly changing therapeutics to improve outcomes.
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Affiliation(s)
- Jeffrey Crawford
- Department of Medicine and Solid Tumor Therapeutics Program, Duke Cancer Institute, Duke University Medical Center, Durham, NC; Division of Medical Oncology, University of Ottawa, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; University of Maryland Greenebaum Cancer Center, Baltimore, MD
| | - Paul Wheatley-Price
- Department of Medicine and Solid Tumor Therapeutics Program, Duke Cancer Institute, Duke University Medical Center, Durham, NC; Division of Medical Oncology, University of Ottawa, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; University of Maryland Greenebaum Cancer Center, Baltimore, MD
| | - Josephine Louella Feliciano
- Department of Medicine and Solid Tumor Therapeutics Program, Duke Cancer Institute, Duke University Medical Center, Durham, NC; Division of Medical Oncology, University of Ottawa, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada; University of Maryland Greenebaum Cancer Center, Baltimore, MD
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McClelland S, Deville C, Thomas CR, Jaboin JJ. An overview of disparities research in access to radiation oncology care. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s13566-016-0284-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chou WC, Chang PH, Lu CH, Liu KH, Hung YS, Hung CY, Liu CT, Yeh KY, Lin YC, Yeh TS. Effect of Comorbidity on Postoperative Survival Outcomes in Patients with Solid Cancers: A 6-Year Multicenter Study in Taiwan. J Cancer 2016; 7:854-61. [PMID: 27162545 PMCID: PMC4860803 DOI: 10.7150/jca.14777] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/15/2016] [Indexed: 12/16/2022] Open
Abstract
Purpose: Patients with comorbidities are more likely to experience treatment-related toxicities and death. Our aim was to examine the effect of comorbidity on postoperative survival outcomes in patients with solid cancers. Methods: In total, 37,288 patients who underwent potentially curative operations for solid cancers at four affiliated hospitals of the Chang Gung Memorial Hospital, between 2007 and 2012, were stratified according to the Charlson Comorbidity Index (CCI) for postoperative survival analysis. Multivariate Cox regression was used to adjust hazard ratios of survival outcomes among different CCI subgroups. Results: A significantly greater proportion of patients with comorbidities presented with poorer clinicopathological characteristics compared to those without. After cancer surgery, 26% of patients died after a median follow-up duration of 38.9 months. Overall mortality rates of patients with CCI scores of 0, 1, 2, 3, 4, and 5-8 were 22.9%, 29.5%, 38.2%, 43.2%, 50.2%, and 56.4%, respectively. After adjusting for other clinicopathological factors, patients with increasing CCI scores were associated with significantly reduced overall and noncancer-specific survival rates, while only patients with CCI scores of >2 were associated with higher cancer-specific mortality rates. Conclusions: Patients with increasing numbers of comorbidities were associated with reduced postoperative survival outcomes. Patients with multiple comorbidities were most vulnerable to both cancer- and noncancer-specific deaths in the first 6 months after cancer surgery. Our results suggest that for both the patient and clinician, it should be taken into consideration about cancer surgery when dealing with multiple comorbidities.
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Affiliation(s)
- Wen-Chi Chou
- 1. Department of Medical Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan;; 2. Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taiwan
| | - Pei-Hung Chang
- 3. Department of Medical Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chang-Hsien Lu
- 4. Department of Medical Oncology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Keng-Hao Liu
- 5. Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Shin Hung
- 1. Department of Medical Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chia-Yen Hung
- 1. Department of Medical Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chien-Ting Liu
- 6. Department of Medical Oncology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Kun-Yun Yeh
- 3. Department of Medical Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yung-Chang Lin
- 1. Department of Medical Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ta-Sen Yeh
- 5. Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
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Access to post-discharge inpatient care after lower limb trauma. J Surg Res 2016; 203:140-4. [PMID: 27338544 DOI: 10.1016/j.jss.2016.02.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 02/06/2016] [Accepted: 02/26/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Most hospitals in the United States are required to provide emergency care to all patients, regardless of insurance status. However, uninsured patients might be unable to access non-acute services, such as post-discharge inpatient care (PDIC). This could result in prolonged acute hospitalization. We tested the hypothesis that insurance status would be independently associated with both PDIC and length of stay (LOS). METHODS An observational study was undertaken using the California State Inpatient Database (2007-2011), which captures 98% of patients admitted to hospital in California. All patients with a diagnosis of orthopedic lower limb trauma were identified using International Classification of Diseases, 9th Revision, Clinical Modification codes 820-828. Multivariable logistic and generalized linear regression models were used to adjust odds of PDIC and LOS for patient and hospital characteristics. RESULTS There were 278,573 patients with orthopedic lower limb injuries, 160,828 (57.7%) of which received PDIC. Uninsured patients had lower odds of PDIC (adjusted odds ratio 0.20, 95% confidence interval 0.17-0.24) and significantly longer hospital LOS (predicted mean difference 1.06 [95% confidence interval 0.78-1.34] d) than those with private insurance. CONCLUSIONS Lack of health insurance is associated with reduced access to PDIC and prolonged hospital LOS. This potential barrier to hospital discharge could reduce the number of trauma beds available for acutely injured patients.
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