title: The effect of surgeon volume on procedure selection in non-small cell lung cancer surgeries.
abstract: OBJECTIVE
  Procedure selection by the surgeon can greatly affect patients' operative and long-term survival. This selection potentially reflects comfort with technically challenging surgeries. This study aims to examine surgeon choices for non-small cell lung cancer and whether surgeon volume predicts the type of procedure chosen, controlling for patient demographics, comorbidity, year of surgery, and institutional factors.
  
  
  METHODS
  Data were abstracted from an Ontario population-based linked database from 2004 to 2011. Patient demographics, comorbidities, year of surgery, and institutional and surgical factors were evaluated. Three-level, random-effect, multilevel regression analyses were performed to examine factors influencing operative selection.
  
  
  RESULTS
  Over the interval, 8070 patients (50.4% were male) underwent surgical resection, including pneumonectomy (n = 842), lobectomy (n = 6212), and wedge resection (n = 1002). Resections were performed by 124 unique physicians in 45 institutions. The proportion of patients undergoing pneumonectomy decreased from 14.8% in 2004 to 7.6% in 2011. Multilevel regression analysis showed physician volume, age, year of procedure, gender, and comorbidities were predictive of performing a pneumonectomy. By adjusting for these variables, the results indicated that for each 10-unit increase in physician volume, the relative risk of performing a pneumonectomy decreased by 9.1% (95% confidence interval, 8.2-10.0, P = .04).
  
  
  CONCLUSIONS
  Although patient and temporal factors influence the type of resection a patient receives for non-small cell lung cancer, surgeon volume also is a strong predictor. This study may be limited by minimal stage data, but the suggestion that a surgeon's total procedural volume for non-small cell lung cancer significantly influences procedure selection has implications on how we deliver care to this patient population.
authors.affiliation: Department of Surgery, McMaster University, St Joseph's Healthcare Hamilton, Hamilton, Ontario.
authors.forename: Ivana
authors.initials: I
authors.lastname: Camposilvan
authors.affiliation: School of Nursing, McMaster University, Hamilton, Ontario.
authors.forename: Noori
authors.initials: N
authors.lastname: Akhtar-Danesh
authors.affiliation: Department of Surgery, McMaster University, St Joseph's Healthcare Hamilton, Hamilton, Ontario.
authors.forename: Laura
authors.initials: L
authors.lastname: Schneider
authors.affiliation: Department of Surgery, McMaster University, St Joseph's Healthcare Hamilton, Hamilton, Ontario. Electronic address: finleyc@mcmaster.ca.
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Finley
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D016208:Databases, Factual; D003695:Delivery of Health Care / Q000639:trends*; D005260:Female; D061847:Hospitals, High-Volume / Q000639:trends*; D061846:Hospitals, Low-Volume / Q000639:trends*; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009864:Ontario; D018579:Patient Selection; D011013:Pneumonectomy / Q000379:methods / Q000639:trends*; D012737:Sex Factors; D066231:Surgeons / Q000639:trends*; D013997:Time Factors
keywords: lung cancer; population; resection; surgeon volume