title: Surgeons' volume-outcome relationship for lobectomies and wedge resections for cancer using video-assisted thoracoscopic techniques.
abstract: This study examined the effect of surgeons' volume on outcomes in lung surgery: lobectomies and wedge resections. Additionally, the effect of video-assisted thoracoscopic surgery (VATS) on cost, utilization, and adverse events was analyzed. The Premier Hospital Database was the data source for this analysis. Eligible patients were those of any age undergoing lobectomy or wedge resection using VATS for cancer treatment. Volume was represented by the aggregate experience level of the surgeon in a six-month window before each surgery. A positive volume-outcome relationship was found with some notable features. The relationship is stronger for cost and utilization outcomes than for adverse events; for thoracic surgeons as opposed to other surgeons; for VATS lobectomies rather than VATS wedge resections. While there was a reduction in cost and resource utilization with greater experience in VATS, these outcomes were not associated with greater experience in open procedures.
authors.affiliation: Associate Professor of Health Care Management, The Wharton School, University of Pennsylvania, 202 Colonial Penn Center, 3641 Locust Walk, Philadelphia, PA 19104, USA.
authors.forename: Guy
authors.initials: G
authors.lastname: David
authors.forename: Candace L
authors.initials: CL
authors.lastname: Gunnarsson
authors.forename: Matt
authors.initials: M
authors.lastname: Moore
authors.forename: John
authors.initials: J
authors.lastname: Howington
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Miller
authors.forename: Michael A
authors.initials: MA
authors.lastname: Maddaus
authors.forename: Robert Joseph
authors.initials: RJ
authors.lastname: McKenna
authors.forename: Bryan F
authors.initials: BF
authors.lastname: Meyers
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Swanson