Comparison Between Veteran and Non-Veteran Populations With Clinical Stage I Non-small Cell Lung Cancer Undergoing Surgery.

Autor:	Heiden BT; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri., Eaton DB Jr; VA St. Louis Health Care System, St. Louis, Missouri., Chang SH; VA St. Louis Health Care System, St. Louis, Missouri.; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri., Yan Y; VA St. Louis Health Care System, St. Louis, Missouri.; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri., Schoen MW; VA St. Louis Health Care System, St. Louis, Missouri.; Division of Hematology and Medical Oncology, Department of internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri., Patel MR; VA St. Louis Health Care System, St. Louis, Missouri., Kreisel D; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.; VA St. Louis Health Care System, St. Louis, Missouri., Nava RG; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.; VA St. Louis Health Care System, St. Louis, Missouri., Meyers BF; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri., Kozower BD; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri., Puri V; Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.; VA St. Louis Health Care System, St. Louis, Missouri.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2023 Mar 01; Vol. 277 (3), pp. e664-e669. Date of Electronic Publication: 2021 May 11.
DOI:	10.1097/SLA.0000000000004928
Abstrakt:	Objective: The aim of this study was to compare quality of care and outcomes between Veteran and non-Veteran patients undergoing surgery for clinical stage I non-small cell lung cancer (NSCLC). Background: Prior studies and the lay media have questioned the quality of care that Veterans with lung cancer receive through the VHA. We hypothesized Veterans undergoing surgery for early-stage NSCLC receive high quality care and have similar outcomes compared to the general population. Methods: We performed a retrospective cohort study of patients with clinical stage I NSCLC undergoing resection from 2006 to 2016 using a VHA dataset. Propensity score matching for baseline patient- and tumor-related variables was used to compare operative characteristics and outcomes between the VHA and the National Cancer Database (NCDB). Results: The unmatched cohorts included 9981 VHA and 176,304 NCDB patients. The VHA had more male, non-White patients with lower education levels, higher incomes, and higher Charlson/Deyo scores. VHA patients had inferior unadjusted 30-day mortality (VHA 2.1% vs NCDB 1.7%, P = 0.011) and median overall survival (69.0 vs 88.7 months, P < 0.001). In the propensity matched cohort of 6792 pairs, VHA patients were more likely to have minimally invasive operations (60.0% vs 39.6%, P < 0.001) and only slightly less likely to receive lobectomies (70.1% vs 70.7%, P = 0.023). VHA patients had longer lengths of stay (8.1 vs 7.1 days, P < 0.001) but similar readmission rates (7.7% vs 7.0%, P = 0.132). VHA patients had significantly better 30-day mortality (1.9% vs 2.8%, P < 0.001) and median overall survival (71.4 vs 65.2 months, P < 0.001). Conclusions: Despite having more comorbidities, Veterans receive exceptional care through the VHA with favorable outcomes, including significantly longer overall survival, compared to the general population. Competing Interests: The authors report no conflicts of interest. (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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