Hospital volume does not predict mortality for patients undergoing lung cancer surgery
Research Activities, September 2012, No. 385
Previous studies have linked better outcomes from lung cancer surgery and high hospital volume of such surgeries. However, these findings remain controversial. A new study, using three different methods to measure hospital volume, sheds new light on the topic. It finds that the way hospital volume is defined determines any impact on mortality and that overall, a hospital's volume of lung cancer surgery is not a predictor of patient mortality. Researchers identified 40,460 lung cancer patients who underwent surgery at 436 hospitals from data in the 2007 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project. This database is maintained by the Agency for Healthcare Research and Quality (AHRQ) and is the largest, all-payer inpatient database available in the United States. Hospital volume of lung surgery was measured using three different methods, including the most commonly used weighted volume stratified into quintiles.
In two of the three methods, there was no significant association between hospital procedure volume and in-hospital mortality. The researchers did find a significant relationship when using the quintile method. In this case, the lowest-volume quintile was associated with more than a 350 percent increase in mortality compared with the highest-volume quintile. However, this relative contribution of volume was a minimal predictor of mortality compared to a patient's age and coexisting disease. The researchers conclude that hospital lung cancer surgery volume should not be used as a proxy measure for that hospital's quality of surgery. The study was supported in part by AHRQ (HS18049, HS17693).
See "The relationship between hospital lung cancer resection volume and patient mortality risk," by Benjamin D. Kozower, M.D., M.P.H., and George J. Stukenborg, Ph.D., in the December 2011 Annals of Surgery 254(6), pp. 1032-1037.