Evolution in the Surgical Care of Patients With Non-Small Cell Lung Cancer in the Mid-South Quality of Surgical Resection Cohort

Autor: Fujin Lu, Laura McHugh, Nibedita Chakraborty, Raymond S. Signore, P. Levy, B. Wolf, Carrie Fehnel, Vishal Sachdev, Cheryl Houston-Harris, Lynn Wiggins, Raymond U. Osarogiagbon, Nicholas Faris, E. Todd Robbins, Matthew P. Smeltzer
Rok vydání: 2016
Předmět:
Male
Lung Neoplasms
Time Factors
Biopsy
030204 cardiovascular system & hematology
Mediastinoscopy
0302 clinical medicine
Mississippi
Carcinoma
Non-Small-Cell Lung
Practice Patterns
Physicians'
Pneumonectomy
Lymph node
Aged
80 and over
Arkansas
medicine.diagnostic_test
Incidence (epidemiology)
Process Assessment
Health Care
General Medicine
Middle Aged
Quality Improvement
Tennessee
medicine.anatomical_structure
Treatment Outcome
Specimen collection
030220 oncology & carcinogenesis
Lymphatic Metastasis
Cohort
Female
Cardiology and Cardiovascular Medicine
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Referral
Context (language use)
Article
03 medical and health sciences
Predictive Value of Tests
medicine
Humans
Healthcare Disparities
Lung cancer
Aged
Neoplasm Staging
Quality Indicators
Health Care
Retrospective Studies
business.industry
General surgery
medicine.disease
Surgery
Health Care Surveys
Lymph Node Excision
business
Zdroj: Seminars in thoracic and cardiovascular surgery. 29(1)
ISSN: 1532-9488
Popis: Surgery is the most important curative treatment modality for patients with early-stage non-small cell lung cancer (NSCLC). We examined the pattern of surgical resection for NSCLC in a high incidence and mortality region of the United States over a 10-year period (2004-2013) in the context of a regional surgical quality improvement initiative. We abstracted patient-level data on all resections at 11 hospitals in 4 contiguous Dartmouth Hospital Referral Regions in North Mississippi, East Arkansas, and West Tennessee. Surgical quality measures focused on intraoperative practice, with emphasis on pathologic nodal staging. We used descriptive statistics and trend analyses to assess changes in practice over time. To measure the effect of an ongoing regional quality improvement intervention with a lymph node specimen collection kit, we used period effect analysis to compare trends between the preintervention and postintervention periods. Of 2566 patients, 18% had no preoperative biopsy, only 15% had a preoperative invasive staging test, and 11% underwent mediastinoscopy. The rate of resections with no mediastinal lymph nodes examined decreased from 48%-32% (P0.0001), whereas the rate of resections examining 3 or more mediastinal stations increased from 5%-49% (P0.0001). There was a significant period effect in the increase in the number of N1, mediastinal, and total lymph nodes examined (all P0.0001). A quality improvement intervention including a lymph node specimen collection kit shows early signs of having a significant positive effect on pathologic nodal examination in this population-based cohort. However, gaps in surgical quality remain.
Databáze: OpenAIRE
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