title: Lobectomy for Lung Cancer at Veterans Administration Medical Center Versus Academic Medical Center.
abstract: BACKGROUND
  Hospital and surgeon volume each have an association with postoperative outcomes. The volume of lung cancer surgery at our Veterans Administration Medical Center (VAMC) is lower than at our academic medical center (AMC). We compared the outcomes after lobectomy at VAMC versus AMC to identify specific areas of clinical care requiring quality improvement.
  
  
  METHODS
  To keep surgeon experience constant, data were derived from a prospective database from a single surgeon. Included were all male patients undergoing lobectomy for non-small cell lung cancer. Postoperative morbidity, mortality, and overall survival were compared after propensity score matching.
  
  
  RESULTS
  From 2004 to 2013, 419 patients were evaluated (338 AMC, 81 VAMC). Outcomes comparison after propensity score matching of 81 AMC patients with 81 VAMC patients found a higher rate of major complications (12% versus 27%, p = 0.02) and longer hospital stay (median 6.0 versus 7.5 days, p < 0.001) for VAMC, but no difference in 90-day mortality (AMC 5% versus VAMC 6%, p > 0.99). Pneumonia was the specific complication found to be higher at VAMC (11% versus AMC 1.2%, p = 0.01). There was no difference in 5-year overall survival for stage I disease (AMC 68% versus VAMC 69%, p = 0.95).
  
  
  CONCLUSIONS
  Keeping surgeon experience constant, and after adjusting for patient factors, the rate of major complication after lobectomy is higher at VAMC. The difference is largely attributable to a higher rate of postoperative pneumonia at VAMC. Complications after pulmonary resection at VAMC could be reduced by implementing quality improvement initiatives aimed at reducing the rate of postoperative pneumonia.
authors.affiliation: Department of Surgery, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Travis
authors.initials: T
authors.lastname: Geraci
authors.affiliation: Department of Surgery, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Baratta
authors.affiliation: Department of Surgery, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: John
authors.initials: J
authors.lastname: Young
authors.affiliation: Department of Surgery, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Steven
authors.initials: S
authors.lastname: Milman
authors.affiliation: Department of Surgery, Alpert Medical School of Brown University, Providence, Rhode Island; Veterans Administration Medical Center, Providence, Rhode Island.
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Dunican
authors.affiliation: Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Richard N
authors.initials: RN
authors.lastname: Jones
authors.affiliation: Department of Surgery, Alpert Medical School of Brown University, Providence, Rhode Island. Electronic address: tng@usasurg.org.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ng
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery*; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology*; D057216:Propensity Score; D011446:Prospective Studies; D012189:Retrospective Studies; D016019:Survival Analysis; D014481:United States; D014493:United States Department of Veterans Affairs