Geographic Variations in Lung Cancer Lobectomy Outcomes: The General Thoracic Surgery Database
| Autor: | Andrzej S. Kosinski, John D. Mitchell, Thomas V. Bilfinger, Maria V. Grau-Sepulveda, A. Laurie Shroyer, Jacquelyn A. Quin, Babatunde A. Yerokun |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty Lung Neoplasms Databases Factual medicine.medical_treatment 030204 cardiovascular system & hematology computer.software_genre Risk Assessment Disease-Free Survival Cohort Studies 03 medical and health sciences 0302 clinical medicine Cause of Death Humans Medicine Pneumonectomy Lung cancer Societies Medical Aged Retrospective Studies Geography Database Thoracic Surgery Video-Assisted business.industry Thoracic Surgery Cancer Retrospective cohort study Odds ratio Middle Aged medicine.disease Survival Analysis United States Cardiothoracic surgery 030220 oncology & carcinogenesis Video-assisted thoracoscopic surgery Female Surgery Cardiology and Cardiovascular Medicine business Risk assessment computer Cohort study |
| Zdroj: | The Annals of Thoracic Surgery. 104:1650-1655 |
| ISSN: | 0003-4975 |
| Popis: | Lung cancer ranks as the top cancer killer in the United States. Using The Society of Thoracic Surgeons General Thoracic Surgery Database (GTSD), the geographic variability of lung cancer lobectomy for operative mortality and major morbidity were examined.From January 2009 to June 2015, the GTSD lung cancer lobectomy records (excluding robotic procedures) were assigned to a US Census region using hospital location. Surgeons performing fewer than seven lung cancer lobectomies per year were categorized as "low volume." The American College of Surgeons Oncology Group criteria were used to classify patients as "high risk." Applying the published GTSD risk algorithms, regional unadjusted and adjusted odds ratios were computed using univariable and multivariable generalized estimating equation logistic regression. Across geographic regions, patient risk factors and outcomes were compared using Kruskal-Wallis and χFrom 2009 to 2015, there were 39,078 lung cancer lobectomies that met study inclusion criteria (31.5% Northeast, 23.5% Midwest, 31.1% South, and 14.0% West). Fewer high-risk cases were seen in the West region (18.9% Northeast, 19.6% Midwest, 19.9% South, and 15.9% West; p 0.001). Across geographic regions, there was no statistically significant difference in the proportion of low-volume surgeons (39.8% Northeast, 44.8% Midwest, 45.8% South, and 56.3% West; p = 0.0512). Adjusted odds ratios for operative mortality and major perioperative morbidity did not show statistically significant differences across regions (p = 0.761 and p = 0.600, respectively).Despite geographic variations in the proportion of high-risk lobectomies, the risk-adjusted mortality and morbidity outcomes did not vary by region. |
| Databáze: | OpenAIRE |
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