title: Ninety-day mortality after resection for lung cancer is nearly double 30-day mortality.
abstract: OBJECTIVE
  To evaluate 30-day and 90-day mortality after major pulmonary resection for lung cancer including the relationship to hospital volume.
  
  
  METHODS
  Major lung resections from 2007 to 2011 were identified in the National Cancer Data Base. Mortality was compared according to annual volume and demographic and clinical covariates using univariate and multivariable analyses, and included information on comorbidity. Statistical significance (P<.05) and 95% confidence intervals were assessed.
  
  
  RESULTS
  There were 124,418 major pulmonary resections identified in 1233 facilities. The 30-day mortality rate was 2.8%. The 90-day mortality rate was 5.4%. Hospital volume was significantly associated with 30-day mortality, with a mortality rate of 3.7% for volumes less than 10, and 1.7% for volumes of 90 or more. Other variables significantly associated with 30-day mortality include older age, male sex, higher stage, pneumonectomy, a previous primary cancer, and multiple comorbidities. Similar results were found for 90-day mortality rates. In the multivariate analysis, hospital volume remained significant with adjusted odds ratios of 2.1 (95% confidence interval [CI], 1.7-2.6) for 30-day mortality and 1.3 (95% CI, 1.1-1.6) for conditional 90-day mortality for the hospitals with the lowest volume (<10) compared with those with the highest volume (>90). Hospitals with a volume less than 30 had an adjusted odds ratio for 30-day mortality of 1.3 (95% CI, 1.2-1.5) compared with those with a volume greater than 30.
  
  
  CONCLUSIONS
  Mortality at 30 and 90 days and hospital volume should be monitored by institutions performing major pulmonary resection and benchmarked against hospitals performing at least 30 resections per year.
authors.affiliation: Department of Surgery, Abington Health, Abington, Pa. Electronic address: cpezzi@abingtonhealth.org.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Pezzi
authors.affiliation: American College of Surgeons, Commission on Cancer, Chicago, Ill.
authors.forename: Katherine
authors.initials: K
authors.lastname: Mallin
authors.affiliation: Department of Surgery, Abington Health, Abington, Pa.
authors.forename: Andres Samayoa
authors.initials: AS
authors.lastname: Mendez
authors.affiliation: American College of Surgeons, Commission on Cancer, Chicago, Ill.
authors.forename: Emmelle
authors.initials: E
authors.lastname: Greer Gay
authors.affiliation: Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tenn.
authors.forename: Joe B
authors.initials: JB
authors.lastname: Putnam
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking / Q000592:standards; D015897:Comorbidity; D005260:Female; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality* / Q000592:standards; D011183:Postoperative Complications / Q000401:mortality*; D019984:Quality Indicators, Health Care / Q000592:standards; D012042:Registries; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult