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Original Research| Volume 64, P32-43, September 2016

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

  • Henrik Møller
    Correspondence
    Corresponding author: Cancer Epidemiology, Population and Global Health, King's College London, Research Oncology, 3rd Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK. Tel.: +44 20 7188 8414.
    Affiliations
    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
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  • Sharma P. Riaz
    Affiliations
    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
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  • Lars Holmberg
    Affiliations
    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
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  • Erik Jakobsen
    Affiliations
    The Danish Lung Cancer Registry, Department of Thoracic Surgery, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
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  • Jesper Lagergren
    Affiliations
    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
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  • Richard Page
    Affiliations
    Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK
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  • Michael D. Peake
    Affiliations
    Public Health England, UK National Cancer Analysis and Registration Service, 2nd Floor Skipton House, 80 London Road, London SE1 6LH, UK
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  • Neil Pearce
    Affiliations
    Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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  • Arnie Purushotham
    Affiliations
    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
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  • Richard Sullivan
    Affiliations
    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
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  • Peter Vedsted
    Affiliations
    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
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  • Margreet Luchtenborg
    Affiliations
    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
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Published:June 18, 2016DOI:https://doi.org/10.1016/j.ejca.2016.05.021
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
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      Highlights

      • •
        This study addresses whether length of stay, re-admission risk and mortality risk in resected lung cancer patients vary between hospitals with small and large procedure volumes.
      • •
        Hospitals with high procedure volume had better mortality outcomes despite adverse case mix, but there were only smaller differences in terms of length of stay and re-admission.
      • •
        The new study contributes to the on-going discussion about the desirability of centralisation of cancer services and provides new information on length of stay and re-admission risks.

      Abstract

      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.

      Keywords

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      References

        • Torre L.A.
        • Bray F.
        • Siegel R.L.
        • Ferlay J.
        • Lortet-Tieulent J.
        • Jemal A.
        Global cancer statistics, 2012.
        CA Cancer J Clin. 2015 Mar; 65 (Epub 2015 Feb 4. PubMed PMID: 25651787): 87-108https://doi.org/10.3322/caac.21262
        View in Article
        • Cancer Research United Kingdom
        Lung cancer mortality statistics.
        http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer/mortality#heading-Two
        (Last accessed 10 September 2015)
        View in Article
        • Riaz S.P.
        • Lüchtenborg M.
        • Coupland V.H.
        • Spicer J.
        • Peake M.D.
        • Møller H.
        Trends in incidence of small cell lung cancer and all lung cancer.
        Lung Cancer. 2012 Mar; 75 (Epub 2011 Sep 3. PubMed PMID: 21893364): 280-284https://doi.org/10.1016/j.lungcan.2011.08.004
        View in Article
        • Sethi T.
        • Lim E.
        • Peake M.
        • Field J.
        • White J.
        • Nicolson M.
        • et al.
        Improving care for patients with lung cancer in the UK.
        Thorax. 2013 Dec; 68 (PubMed PMID: 24204006): 1181-1185https://doi.org/10.1136/thoraxjnl-2013-204588
        View in Article
        • Lau K.K.
        • Rathinam S.
        • Waller D.A.
        • Peake M.D.
        The effects of increased provision of thoracic surgical specialists on the variation in lung cancer resection rate in England.
        J Thorac Oncol. 2013 Jan; 8 (PubMed PMID: 23242439): 68-72https://doi.org/10.1097/JTO.0b013e3182762315
        View in Article
        • Khakwani A.
        • Rich A.L.
        • Powell H.A.
        • Tata J.L.
        • Stanley R.A.
        • Baldwin D.R.
        • et al.
        The impact of the 'hub and spoke' model of care for lung cancer and equitable access to surgery.
        Thorax. 2015 Feb; 70 (Epub 2014 Sep 2. PubMed PMID: 25182047): 146-151https://doi.org/10.1136/thoraxjnl-2014-205841
        View in Article
      7. Lung cancer: the diagnosis and treatment of lung cancer. NICE Guidelines, April 2011 ([CG121])
        https://www.nice.org.uk/guidance/cg121
        (Last accessed 10 September)
        View in Article
        • Khakwani A.
        • Rich A.L.
        • Powell H.A.
        • Tata J.L.
        • Stanley R.A.
        • Baldwin D.R.
        • et al.
        Lung cancer survival in England: trends in non-small-cell lung cancer survival over the duration of the National Lung Cancer Audit.
        Br J Cancer. 2013 Oct 15; 109 (Epub 2013 Sep 19. PubMed PMID: 24052044; PubMed Central PMCID: PMC3798968): 2058-2065https://doi.org/10.1038/bjc.2013.572
        View in Article
        • Riaz S.P.
        • Lüchtenborg M.
        • Jack R.H.
        • Coupland V.A.
        • Linklater K.M.
        • Peake M.D.
        • et al.
        Variation in surgical resection for lung cancer in relation to survival: population-based study in England 2004–2006.
        Eur J Cancer. 2012 Jan; 48 (Epub 2011 Aug 24. PubMed PMID: 21871792): 54-60https://doi.org/10.1016/j.ejca.2011.07.012
        View in Article
        • Walters S.
        • Benitez-Majano S.
        • Muller P.
        • Coleman M.P.
        • Allemani C.
        • Butler J.
        • et al.
        Is England closing the international gap in cancer survival?.
        Br J Cancer. 2015 Sep 1; 113 (Epub 2015 Aug 4. PubMed PMID: 26241817; PubMed Central PMCID: PMC4559829): 848-860https://doi.org/10.1038/bjc.2015.265
        View in Article
        • Lüchtenborg M.
        • Riaz S.P.
        • Coupland V.H.
        • Lim E.
        • Jakobsen E.
        • Krasnik M.
        • et al.
        High procedure volume is strongly associated with improved survival after lung cancer surgery.
        J Clin Oncol. 2013 Sep 1; 31 (Epub 2013 Jul 29. PubMed PMID: 23897962): 3141-3146https://doi.org/10.1200/JCO.2013.49.0219
        View in Article

      12. National Lung Cancer Audit https://www.rcplondon.ac.uk/projects/national-lung-cancer-audit.

        View in Article
        • Cheung M.C.
        • Hamilton K.
        • Sherman R.
        • Byrne M.M.
        • Nguyen D.M.
        • Franceschi D.
        • et al.
        Impact of teaching facility status and high-volume centers on outcomes for lung cancer resection: an examination of 13,469 surgical patients.
        Ann Surg Oncol. 2009 Jan; 16 (Epub 2008 Jul 4. PubMed PMID: 18600379): 3-13https://doi.org/10.1245/s10434-008-0025-9
        View in Article
        • Learn P.A.
        • Bach P.B.
        A decade of mortality reductions in major oncologic surgery: the impact of centralization and quality improvement.
        Med Care. 2010 Dec; 48 (PubMed PMID: 20966781): 1041-1049https://doi.org/10.1097/MLR.0b013e3181f37d5f
        View in Article
        • Finks J.F.
        • Osborne N.H.
        • Birkmeyer J.D.
        Trends in hospital volume and operative mortality for high-risk surgery.
        N Engl J Med. 2011 Jun 2; 364 (PubMed PMID: 21631325; PubMed Central PMCID: PMC3150488): 2128-2137https://doi.org/10.1056/NEJMsa1010705
        View in Article
        • Coupland V.H.
        • Lagergren J.
        • Lüchtenborg M.
        • Jack R.H.
        • Allum W.
        • Holmberg L.
        • et al.
        Hospital volume, proportion resected and mortality from oesophageal and gastric cancer: a population-based study in England, 2004–2008.
        Gut. 2013 Jul; 62 (Epub 2012 Oct 19. PubMed PMID: 23086798): 961-966https://doi.org/10.1136/gutjnl-2012-303008
        View in Article
        • Pezzi C.M.
        • Mallin K.
        • Mendez A.S.
        • Greer Gay E.
        • Putnam Jr., J.B.
        Ninety-day mortality after resection for lung cancer is nearly double 30-day mortality.
        J Thorac Cardiovasc Surg. 2014 Nov; 148 (Epub 2014 Aug 4. PubMed PMID: 25172318): 2269-2277https://doi.org/10.1016/j.jtcvs.2014.07.077
        View in Article
        • Otake H.
        • Yasunaga H.
        • Horiguchi H.
        • Matsutani N.
        • Matsuda S.
        • Ohe K.
        Impact of hospital volume on chest tube duration, length of stay, and mortality after lobectomy.
        Ann Thorac Surg. 2011 Sep; 92 (PubMed PMID: 21871302): 1069-1074https://doi.org/10.1016/j.athoracsur.2011.04.087
        View in Article
        • Handy Jr., J.R.
        • Denniston K.
        • Grunkemeier G.L.
        • Wu Y.X.
        What is the inpatient cost of hospital complications or death after lobectomy or pneumonectomy?.
        Ann Thorac Surg. 2011 Jan; 91 (PubMed PMID: 21172519): 234-238https://doi.org/10.1016/j.athoracsur.2010.08.043
        View in Article
        • Park H.S.
        • Detterbeck F.C.
        • Boffa D.J.
        • Kim A.W.
        Impact of hospital volume of thoracoscopic lobectomy on primary lung cancer outcomes.
        Ann Thorac Surg. 2012 Feb; 93 (Epub 2011 Sep 25. PubMed PMID: 21945225): 372-379https://doi.org/10.1016/j.athoracsur.2011.06.054
        View in Article
        • Kelly M.
        • Sharp L.
        • Dwane F.
        • Kelleher T.
        • Drummond F.J.
        • Comber H.
        Factors predicting hospital length-of-stay after radical prostatectomy: a population-based study.
        BMC Health Serv Res. 2013 Jul 2; 13 (PubMed PMID: 23816338; PubMed Central PMCID: PMC3750445): 244https://doi.org/10.1186/1472-6963-13-244
        View in Article
        • McDevitt J.
        • Kelly M.
        • Comber H.
        • Kelleher T.
        • Dwane F.
        • Sharp L.
        A population-based study of hospital length of stay and emergency readmission following surgery for non-small-cell lung cancer.
        Eur J Cardiothorac Surg. 2013 Oct; 44 (Epub 2013 Jul 25. PubMed PMID: 23886994; PubMed Central PMCID: PMC4036404): e253-9https://doi.org/10.1093/ejcts/ezt389
        View in Article
        • Rosen J.E.
        • Hancock J.G.
        • Kim A.W.
        • Dettereck F.
        • Boffa D.J.
        Predictors of mortality after surgical management of lung cancer in the National Cancer Database.
        Ann Thorac Surg. 2014 Dec; 98 (Epub 2014 Oct 18. PubMed PMID: 25443003): 1953-1960https://doi.org/10.1016/j.athoracsur.2014.07.007
        View in Article
        • Hu Y.
        • McMurry T.L.
        • Isbell J.M.
        • Stukenborg G.J.
        • Kozower B.D.
        Readmission after lung cancer resection is associated with a 6-fold increase in 90-day postoperative mortality.
        J Thorac Cardiovasc Surg. 2014 Nov; 148 (Epub 2014 Apr 18. PubMed PMID: 24823283; PubMed Central PMCID: PMC4201876): 2261-2267.e1https://doi.org/10.1016/j.jtcvs.2014.04.026
        View in Article
        • Avritscher E.B.
        • Cooksley C.D.
        • Rolston K.V.
        • Swint J.M.
        • Delclos Gl
        • Franzini L.
        • et al.
        Serious postoperative infections following resection of common solid tumors: outcomes, costs, and impact of hospital surgical volume.
        Support Care Cancer. 2014 Feb; 22 (Epub 2013 Oct 19. PubMed PMID: 24141699): 527-535https://doi.org/10.1007/s00520-013-2006-1
        View in Article
        • Merkow R.P.
        • Ju M.H.
        • Chung J.W.
        • Hall B.L.
        • Cohen M.E.
        • Williams M.V.
        • et al.
        Underlying reasons associated with hospital readmission following surgery in the United States.
        JAMA. 2015 Feb 3; 313 (PubMed PMID: 25647204): 483-495https://doi.org/10.1001/jama.2014.18614
        View in Article
        • Dimick J.B.
        • Ghaferi A.A.
        Hospital readmission as a quality measure in surgery.
        JAMA. 2015 Feb 3; 313 (PubMed PMID: 25647207): 512-513https://doi.org/10.1001/jama.2014.14179
        View in Article
        • Horwitz L.I.
        • Lin Z.
        • Herrin J.
        • Bernheim S.
        • Drye E.E.
        • Krumholz H.M.
        • et al.
        Association of hospital volume with readmission rates: a retrospective cross-sectional study.
        BMJ. 2015 Feb 9; 350 (Erratum in: BMJ. 2015;350:h895. Hines, Harold J Jr [added]. PubMed PMID: 25665806; PubMed Central PMCID: PMC4353286): h447https://doi.org/10.1136/bmj.h447
        View in Article
        • Stitzenberg K.B.
        • Chang Y.
        • Smith A.B.
        • Nielsen M.E.
        Exploring the burden of inpatient readmissions after major cancer surgery.
        J Clin Oncol. 2015 Feb 10; 33 (Epub 2014 Dec 29. PubMed PMID: 25547502; PubMed Central PMCID: PMC4314594): 455-464https://doi.org/10.1200/JCO.2014.55.5938
        View in Article
        • Puri V.
        • Patel A.P.
        • Crabtree T.D.
        • Bell J.M.
        • Broderick S.R.
        • Kreisel D.
        • et al.
        Unexpected readmission after lung cancer surgery: a benign event?.
        J Thorac Cardiovasc Surg. 2015 Aug 28; (pii: S0022–5223(15)01530-5 [Epub ahead of print] PubMed PMID: 26410004)https://doi.org/10.1016/j.jtcvs.2015.08.067
        View in Article
        • Henneman D.
        • Dikken J.L.
        • Putter H.
        • Lemmens V.E.
        • Van der Geest L.G.
        • van Hillegersberg R.
        • et al.
        Centralization of esophagectomy: how far should we go?.
        Ann Surg Oncol. 2014 Dec; 21 (Epub 2014 Jul 9. PubMed PMID: 25005073): 4068-4074https://doi.org/10.1245/s10434-014-3873-5
        View in Article
        • Piaggio G.
        • Elbourne D.R.
        • Pocock S.J.
        • Evans S.J.
        • Altman D.G.
        • CONSORT Group
        Reporting of non-inferiority and equivalence randomized trials: extension of the CONSORT 2010 statement.
        JAMA. 2012 Dec 26; 308 (PubMed PMID: 23268518): 2594-2604https://doi.org/10.1001/jama.2012.87802
        View in Article
        • Crawford S.M.
        • Sauerzapf V.
        • Haynes R.
        • Zhao H.
        • Forman D.
        • Jones A.P.
        Social and geographical factors affecting access to treatment of lung cancer.
        Br J Cancer. 2009 Sep 15; 101 (Epub 2009 Aug 18. PubMed PMID: 19690543; PubMed Central PMCID: PMC2743361): 897-901https://doi.org/10.1038/sj.bjc.6605257
        View in Article
        • Peake M.D.
        Deprivation, distance and death in lung cancer.
        Thorax. 2015 Feb; 70 (Epub 2014 Oct 13. PubMed PMID: 25311470): 108-109https://doi.org/10.1136/thoraxjnl-2014-206153
        View in Article

      Article info

      Publication history

      Published online: June 18, 2016
      Accepted: May 17, 2016
      Received in revised form: May 16, 2016
      Received: April 5, 2016

      Identification

      DOI: https://doi.org/10.1016/j.ejca.2016.05.021

      Copyright

      © 2016 Published by Elsevier Ltd.

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