A case-mix model for monitoring of postoperative mortality after surgery for lung cancer.
BACKGROUND
Postoperative mortality (POM) after surgery for lung cancer has been proposed as a performance indicator. Information on the size of the risk and its prognostic factors is needed to serve as a reference standard.


METHODS
Electronic records from the Rotterdam Cancer Registry (n=2337) and the Thames Cancer Registry (n=3772) were retrieved and analysed by sex, age, period, histology, region and extent of surgery. Multivariable logistic regression analysis was used to determine prognostic factors, to calculate odds ratios (OR) and to develop a case-mix model.


RESULTS
POM was 4.2% (n=257) on average and increased with age from 1.7% for patients younger than 60 years up to 9.4% for octogenarians. After lobectomy, POM was 2.9% against 6.0% and 9.5% after pneumonectomy left and right, respectively. Multivariable analysis showed higher risk for men (OR=1.4) and lower risk for adenocarcinoma (OR=0.6).


CONCLUSIONS
The final prediction model supports comparison and monitoring of POM rates for lung cancer. Only a limited number of risk factors need to be registered to allow adjustment for case-mix.
Damhuis
Ronald
R
Rotterdam Cancer Registry, P.O. Box 289, 3000 AG Rotterdam, The Netherlands. damhuis@ikr.nl
Coonar
Aman
A
Plaisier
Peter
P
Dankers
Marlies
M
Bekkers
Jos
J
Linklater
Karen
K
Møller
Henrik
H
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011013:Pneumonectomy; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D020379:Risk Adjustment / Q000379:methods*; D017678:Sex Distribution; D015996:Survival Rate / Q000639:trends