title: Impact of hospital volume of thoracoscopic lobectomy on primary lung cancer outcomes.
abstract: BACKGROUND
  This study evaluated hospital operative volume of video-assisted thoracoscopic surgery (VATS) lobectomy in primary lung cancer as a predictor of short-term outcomes after pulmonary lobectomy on a national scale. Some previous analyses comparing VATS vs open lobectomy outcomes have been limited by inaccuracies in patient cohort identification.
  
  
  METHODS
  The 2008 Healthcare Utilization Project-Nationwide Inpatient Sample database was culled using the International Classification of Diseases (9th Clinical Modification) procedure codes specifically distinguishing VATS vs open lobectomies (32.41 and 32.49, respectively) available only after October 2007. High hospital VATS volume was defined as 95th percentile or higher (>20 VATS/year). Univariable and multivariable analyses were used to identify independent predictors of the following outcome measures: 30-day in-hospital morbidity and mortality, hospital length of stay (LOS), and hospital costs.
  
  
  RESULTS
  We identified 6,292 primary lung cancer patients undergoing pulmonary lobectomy, including 1,523 undergoing VATS (24%). Compared with open, VATS patients had fewer complications (38% vs 44%, p<0.001) and median LOS (5 vs 7 days; p<0.001). In multivariable analysis, VATS was an independent predictor of fewer total complications (odds ratio, 0.83; p=0.004) and shorter LOS (2.3±0.3-day difference, p<0.001). Patients undergoing VATS at high-volume VATS hospitals had shorter median LOS (4 vs 6 days, p=0.001) compared with low-volume VATS hospitals. Multivariable analysis showed high hospital VATS volume independently predicted shorter LOS (0.9±0.4-day difference, p=0.001).
  
  
  CONCLUSIONS
  In a national database, VATS lobectomy was associated with fewer complications and shorter LOS than open lobectomy in primary lung cancer patients. Among patients undergoing VATS, high hospital volume was also associated with shorter LOS.
authors.affiliation: Section of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
authors.forename: Henry S
authors.initials: HS
authors.lastname: Park
authors.forename: Frank C
authors.initials: FC
authors.lastname: Detterbeck
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Boffa
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Kim
mesh_terms: D000368:Aged; D015897:Comorbidity; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D012959:Socioeconomic Factors; D020775:Thoracic Surgery, Video-Assisted / Q000706:statistics & numerical data*; D013908:Thoracotomy / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D016526:Workload / Q000706:statistics & numerical data