title: The impact of hospital and surgeon volume on the 30-day mortality of lung cancer surgery: A nation-based reappraisal.
abstract: OBJECTIVE
  Our objective was to analyze the time trend variation of 30-day mortality after lung cancer surgery, and to quantify the impact of surgeon and hospital volumes over a 5-year period in France.
  
  
  METHODS
  We used Epithor, the French national thoracic database and benchmark tool, which catalogues more than 180,000 procedures of 89 private and public hospitals in France. From January 2005 to December 2010, 19,556 patients who underwent major lung resection (lobectomy, bilobectomy, pneumonectomy) were included in our study. Multilevel logistic models were designed to investigate the relationship between 30-day mortality and surgeon (model 1) or hospital (model 2) volumes. The 3 levels considered were the patient, the surgeon, and the hospital.
  
  
  RESULTS
  From 2005 to 2007, the 30-day mortality of patients who underwent major lung resection averaged 10%, and then decreased until it reached 3.8% in 2010 (P < .0001). A significant decrease in 30-day mortality was observed over time (P = .0046). During the study period, the mean annual number of procedures per surgeon was 46.1 (standard deviation [SD] = 23.6) and per hospital was 97.9 (SD = 50.8). Model 1 showed that surgeon volume had a significant impact on 30-day mortality (P = .03), whereas model 2 failed to show that hospital volume influenced 30-day mortality (P = .75).
  
  
  CONCLUSIONS
  Since 2007, when France's first National Cancer Plan became effective, 30-day mortality of primary lung cancer surgery has decreased and currently measures 3.8%. Low mortality was correlated with higher surgeon volume but was not influenced by hospital volume, which cannot be considered a proxy measure for determining the safety of lung cancer surgery.
authors.affiliation: Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France. Electronic address: pierre-emmanuel.falcoz@wanadoo.fr.
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Falcoz
authors.affiliation: Clinical Methodology Center, Besançon University Hospital, Besançon, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Puyraveau
authors.affiliation: Department of Thoracic Surgery, Bayonne Hospital, Bayonne, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Rivera
authors.affiliation: Department of Thoracic Surgery, Dijon University Hospital, Dijon, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Bernard
authors.affiliation: Department of Thoracic Surgery, Strasbourg University Hospital, Strasbourg, France.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Massard
authors.affiliation: Clinical Methodology Center, Besançon University Hospital, Besançon, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Mauny
authors.affiliation: Department of Thoracic Surgery, Toulouse University Hospital, Toulouse, France.
authors.forename: Marcel
authors.initials: M
authors.lastname: Dahan
authors.affiliation: Department of Thoracic Surgery, Marseille University Hospital, Marseille, France.
authors.forename: Pascal-Alexandre
authors.initials: PA
authors.lastname: Thomas
mesh_terms: D000368:Aged; D002983:Clinical Competence; D005260:Female; D005602:France; D017052:Hospital Mortality / Q000639:trends; D061847:Hospitals, High-Volume / Q000639:trends*; D061846:Hospitals, Low-Volume / Q000639:trends*; D016304:Hospitals, Private / Q000639:trends; D006779:Hospitals, Public / Q000639:trends; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality* / Q000639:trends*; D019984:Quality Indicators, Health Care / Q000639:trends*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome