High lung cancer surgical procedure volume is associated with shorter length of stay and lower risks of re-admission and death: National cohort analysis in England.
It is debated whether treating cancer patients in high-volume surgical centres can lead to improvement in outcomes, such as shorter length of hospital stay, decreased frequency and severity of post-operative complications, decreased re-admission, and decreased mortality. The dataset for this analysis was based on cancer registration and hospital discharge data and comprised information on 15,738 non-small-cell lung cancer patients resident and diagnosed in England in 2006-2010 and treated by surgical resection. The number of lung cancer resections was computed for each hospital in each calendar year, and patients were assigned to a hospital volume quintile on the basis of the volume of their hospital. Hospitals with large lung cancer surgical resection volumes were less restrictive in their selection of patients for surgical management and provided a higher resection rate to their geographical population. Higher volume hospitals had shorter length of stay and the odds of re-admission were 15% lower in the highest hospital volume quintile compared with the lowest quintile. Mortality risks were 1% after 30 d and 3% after 90 d. Patients from hospitals in the highest volume quintile had about half the odds of death within 30 d than patients from the lowest quintile. Variations in outcomes were generally small, but in the same direction, with consistently better outcomes in the larger hospitals. This gives support to the ongoing trend towards centralisation of clinical services, but service re-organisation needs to take account of not only the size of hospitals but also referral routes and patient access.
King's College London, Cancer Epidemiology, Population and Global Health, Research Oncology, 3rd Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, UK; Public Health England, UK National Cancer Analysis and Registration Service, 2nd Floor Skipton House, 80 London Road, London SE1 6LH, UK; Research Unit for General Practice and Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark. Electronic address: henrik.moller@kcl.ac.uk.
Henrik
H
Møller
Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, UK. Electronic address: S.sheikh@qmul.ac.uk.
Sharma P
SP
Riaz
King's College London, Cancer Epidemiology, Population and Global Health, Research Oncology, 3rd Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK. Electronic address: Lars.holmberg@kcl.ac.uk.
Lars
L
Holmberg
The Danish Lung Cancer Registry, Department of Thoracic Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark. Electronic address: Erik.jakobsen@rsyd.dk.
Erik
E
Jakobsen
King's College London, Cancer Epidemiology, Population and Global Health, Research Oncology, 3rd Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK; Department of Molecular Medicine and Surgery (MMK), K1, Upper Gastrointestinal Research, Övre gastrointestinal forskning, NS 67, Institutionen för molekylär medicin och kirurgi, Karolinska Institutet, 171 76 Stockholm, Sweden. Electronic address: Jesper.lagergren@kcl.ac.uk.
Jesper
J
Lagergren
Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK. Electronic address: Richard.page@lhch.nhs.uk.
Richard
R
Page
Public Health England, UK National Cancer Analysis and Registration Service, 2nd Floor Skipton House, 80 London Road, London SE1 6LH, UK. Electronic address: Mick.peake@phe.gov.uk.
Michael D
MD
Peake
Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Electronic address: Neil.pearce@lshtm.ac.uk.
Neil
N
Pearce
King's College London, Cancer Epidemiology, Population and Global Health, Research Oncology, 3rd Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK. Electronic address: arniepurushotham@gmail.com.
Arnie
A
Purushotham
King's College London, Cancer Epidemiology, Population and Global Health, Research Oncology, 3rd Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK. Electronic address: Richard.sullivan@kcl.ac.uk.
Richard
R
Sullivan
Research Unit for General Practice and Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark. Electronic address: P.vedsted@feap.dk.
Peter
P
Vedsted
King's College London, Cancer Epidemiology, Population and Global Health, Research Oncology, 3rd Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK; Public Health England, UK National Cancer Analysis and Registration Service, 2nd Floor Skipton House, 80 London Road, London SE1 6LH, UK. Electronic address: Margreet.luchtenborg@kcl.ac.uk.
Margreet
M
Luchtenborg
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004739:England; D005260:Female; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data*; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D055815:Young Adult
Cohort study; Epidemiology; Lung cancer; Procedure volume; Surgery