Impact of Hospital Volume on Outcomes of Elective Pneumonectomy in the United States
| Autor: | Esteban Aguayo, Vishal Dobaria, Peyman Benharash, Yas Sanaiha, Joseph Hadaya, Ava Mandelbaum, Sha’Shonda L. Revels |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Hospitals Low-Volume Lung Neoplasms medicine.medical_treatment 030204 cardiovascular system & hematology Odds 03 medical and health sciences Pneumonectomy Postoperative Complications 0302 clinical medicine Hospital volume medicine Humans Hospital Mortality Mesothelioma Hospital Costs Aged Perioperative management business.industry Middle Aged medicine.disease United States Confidence interval Hospitalization Survival Rate Failure to Rescue Health Care 030228 respiratory system Quartile Elective Surgical Procedures Emergency medicine Female Surgery Cardiology and Cardiovascular Medicine business Complication Hospitals High-Volume |
| Zdroj: | The Annals of Thoracic Surgery. 110:1874-1881 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2020.04.115 |
| Popis: | Background Despite advances in surgical technique and perioperative management, pneumonectomy remains associated with significant morbidity and mortality. The purpose of this study was to examine the impact of annual institutional volume of anatomic lung resections on outcomes after elective pneumonectomy. Methods We evaluated all patients who underwent elective pneumonectomy from 2005 to 2014 in the National Inpatient Sample. Patients less than 18 years of age, or with trauma-related diagnoses, mesothelioma, or a nonelective admission were excluded. Hospitals were divided into volume quartiles based on annual institutional anatomic lung resection caseload. We studied the effect of institutional volume on inhospital mortality, complications, and failure to rescue, as well as costs and length of stay. Results During the study period, an estimated 22,739 patients underwent pneumonectomy, with a reduction in national mortality from 7.9% to 5.5% (P trend = .045). Compared with the highest volume centers, operations performed at the lowest volume hospitals were associated with 1.74 increased odds of mortality (95% confidence interval, 1.14 to 2.66). Despite similar odds of postoperative complications, low volume hospital status was associated with increased failure to rescue rates (18.3% vs 12.7%, P = .024) and adjusted odds of mortality (1.70; 95% confidence interval, 1.09 to 2.64) after any complication. Conclusions High volume hospital status is strongly associated with reduced mortality and failure to rescue rates after pneumonectomy. Efforts to centralize care or disseminate best practices may lead to improved national outcomes for this high-risk procedure. |
| Databáze: | OpenAIRE |
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