Impact of teaching facility status and high-volume centers on outcomes for lung cancer resection

An examination of 13,469 surgical patients

Michael C. Cheung, Kara Hamilton, Recinda Sherman, Margaret M. Byrne, Dao M. Nguyen, Dido Franceschi, Leonidas Koniaris

Research output: Contribution to journalArticle

109 Citations (Scopus)

Abstract

Background: Studies suggest that institutional case volume and teaching status significantly affect patient survival. We sought to compare outcomes of surgical resection for lung cancer at teaching facilities (TF) and at high-volume centers (HVC). Methods: Patients undergoing lung cancer resection with curative intent were examined using a linked dataset from 1998 to 2002 between the Florida Cancer Data System and the Florida Agency for Health Care Administration. Results: A total of 13,469 patients were analyzed and outcomes adjusted for comorbidities. Median survival time (MST) was superior for patients treated at TF versus nonteaching facilities (NTF) (47.1 versus 40.5 months, P <0.001). Mortality rates at NTF were higher at 30 days (2.6% versus 1.1%, P <0.001), 90 days (6.8% versus 3.8%, P <0.001), and at 5 years (63.9% versus 59.2%, P = 0.005). Similarly, MST was superior in the cohort treated at HVC versus low-volume center (LVC) (45.1 versus 39.8 months, P <0.001). Mortality was observed to be higher in LVC than HVC at 30 days (2.7% versus 1.6%, P <0.001), 90 days (7.5% versus 4.0%, P <0.001), and at 5 years (63.5% versus 59.3%, P = 0.002). Significant preoperative, independent predictors of survival include age, sex, smoking status, and the existence of certain comorbidities. Treatment at a TF or HVC were independent predictors of better outcome. Race, use of chemotherapy or radiation did not affect outcomes. Conclusion: Surgical treatment for lung cancer at TF or HVC results in significantly better short- and long-term patient outcomes.

Original languageEnglish (US)
Pages (from-to)3-13
Number of pages11
JournalAnnals of Surgical Oncology
Volume16
Issue number1
DOIs
StatePublished - Jan 2009
Externally publishedYes

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Lung Neoplasms
Teaching
Survival
Comorbidity
Mortality
Information Systems
Smoking
Radiation
Delivery of Health Care
Drug Therapy
Therapeutics
Neoplasms

Keywords

  • Lung cancer
  • Outcomes
  • Teaching
  • Volume

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Impact of teaching facility status and high-volume centers on outcomes for lung cancer resection : An examination of 13,469 surgical patients. / Cheung, Michael C.; Hamilton, Kara; Sherman, Recinda; Byrne, Margaret M.; Nguyen, Dao M.; Franceschi, Dido; Koniaris, Leonidas.

In: Annals of Surgical Oncology, Vol. 16, No. 1, 01.2009, p. 3-13.

Research output: Contribution to journalArticle

Cheung, Michael C. ; Hamilton, Kara ; Sherman, Recinda ; Byrne, Margaret M. ; Nguyen, Dao M. ; Franceschi, Dido ; Koniaris, Leonidas. / Impact of teaching facility status and high-volume centers on outcomes for lung cancer resection : An examination of 13,469 surgical patients. In: Annals of Surgical Oncology. 2009 ; Vol. 16, No. 1. pp. 3-13.
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abstract = "Background: Studies suggest that institutional case volume and teaching status significantly affect patient survival. We sought to compare outcomes of surgical resection for lung cancer at teaching facilities (TF) and at high-volume centers (HVC). Methods: Patients undergoing lung cancer resection with curative intent were examined using a linked dataset from 1998 to 2002 between the Florida Cancer Data System and the Florida Agency for Health Care Administration. Results: A total of 13,469 patients were analyzed and outcomes adjusted for comorbidities. Median survival time (MST) was superior for patients treated at TF versus nonteaching facilities (NTF) (47.1 versus 40.5 months, P <0.001). Mortality rates at NTF were higher at 30 days (2.6{\%} versus 1.1{\%}, P <0.001), 90 days (6.8{\%} versus 3.8{\%}, P <0.001), and at 5 years (63.9{\%} versus 59.2{\%}, P = 0.005). Similarly, MST was superior in the cohort treated at HVC versus low-volume center (LVC) (45.1 versus 39.8 months, P <0.001). Mortality was observed to be higher in LVC than HVC at 30 days (2.7{\%} versus 1.6{\%}, P <0.001), 90 days (7.5{\%} versus 4.0{\%}, P <0.001), and at 5 years (63.5{\%} versus 59.3{\%}, P = 0.002). Significant preoperative, independent predictors of survival include age, sex, smoking status, and the existence of certain comorbidities. Treatment at a TF or HVC were independent predictors of better outcome. Race, use of chemotherapy or radiation did not affect outcomes. Conclusion: Surgical treatment for lung cancer at TF or HVC results in significantly better short- and long-term patient outcomes.",
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AU - Byrne, Margaret M.

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AB - Background: Studies suggest that institutional case volume and teaching status significantly affect patient survival. We sought to compare outcomes of surgical resection for lung cancer at teaching facilities (TF) and at high-volume centers (HVC). Methods: Patients undergoing lung cancer resection with curative intent were examined using a linked dataset from 1998 to 2002 between the Florida Cancer Data System and the Florida Agency for Health Care Administration. Results: A total of 13,469 patients were analyzed and outcomes adjusted for comorbidities. Median survival time (MST) was superior for patients treated at TF versus nonteaching facilities (NTF) (47.1 versus 40.5 months, P <0.001). Mortality rates at NTF were higher at 30 days (2.6% versus 1.1%, P <0.001), 90 days (6.8% versus 3.8%, P <0.001), and at 5 years (63.9% versus 59.2%, P = 0.005). Similarly, MST was superior in the cohort treated at HVC versus low-volume center (LVC) (45.1 versus 39.8 months, P <0.001). Mortality was observed to be higher in LVC than HVC at 30 days (2.7% versus 1.6%, P <0.001), 90 days (7.5% versus 4.0%, P <0.001), and at 5 years (63.5% versus 59.3%, P = 0.002). Significant preoperative, independent predictors of survival include age, sex, smoking status, and the existence of certain comorbidities. Treatment at a TF or HVC were independent predictors of better outcome. Race, use of chemotherapy or radiation did not affect outcomes. Conclusion: Surgical treatment for lung cancer at TF or HVC results in significantly better short- and long-term patient outcomes.

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