Lung Cancer Resection at Hospitals With High vs Low Mortality Rates.
OBJECTIVE
Wide variations in mortality rates exist across hospitals following lung cancer resection; however, the factors underlying these differences remain unclear.


OBJECTIVE
To evaluate perioperative outcomes in patients who underwent lung cancer resection at hospitals with very high and very low mortality rates (high-mortality hospitals [HMHs] and low-mortality hospitals [LMHs]) to better understand the factors related to differences in mortality rates after lung cancer resection.


METHODS
In this retrospective cohort study, 1279 hospitals that were accredited by the Commission on Cancer were ranked on a composite measure of risk-adjusted mortality following major cancer resections performed from January 1, 2005, through December 31, 2006. We collected data from January 1, 2006, through December 31, 2007, on 645 lung resections in 18 LMHs and 25 HMHs. After adjusting for patient characteristics, we used hierarchical logistic regression to examine differences in the incidence of complications and "failure-to-rescue" rates (defined as death following a complication).


METHODS
Rates of adherence to processes of care, incidence of complications, and failure to rescue following complications.


RESULTS
Among 645 patients who received lung resections (441 in LMHs and 204 in HMHs), the overall unadjusted mortality rates were 1.6% (n = 7) vs 10.8% (n = 22; P < .001) for LMHs and HMHs, respectively. Following risk adjustment, the difference in mortality rates was attenuated (1.8% vs 8.1%; P < .001) but remained significant. Overall, complication rates were higher in HMHs (23.3% vs 15.6%; adjusted odds ratio [aOR], 1.79; 95% CI, 0.99-3.21), but this difference was not significant. The likelihood of any surgical (aOR, 0.73; 95% CI, 0.26-2.00) or cardiopulmonary (aOR, 1.23; 95% CI, 0.70-2.16) complications was similar between LMHs and HMHs. However, failure-to-rescue rates were significantly higher in HMHs (25.9% vs 8.7%; aOR, 6.55; 95% CI, 1.44-29.88).


CONCLUSIONS
Failure-to-rescue rates are higher at HMHs, which may explain the large differences between hospitals in mortality rates following lung cancer resection. This finding emphasizes the need for better understanding of the factors related to complications and their subsequent management.
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor.
Tyler R
TR
Grenda
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor.
Sha'Shonda L
SL
Revels
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor.
Huiying
H
Yin
Dartmouth-Hitchcock Health Care System, Hanover, New Hampshire.
John D
JD
Birkmeyer
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor.
Sandra L
SL
Wong
D000368:Aged; D002423:Cause of Death; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D019990:Perioperative Care; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D013503:Surgery Department, Hospital; D015996:Survival Rate