Original articleGeneral thoracicOutcomes and Costs for Major Lung Resection in the United States: Which Patients Benefit Most From High-Volume Referral?
Section snippets
Data Sources
Patient-level discharge data were obtained using the Nationwide Inpatient Sample (NIS) for years 2007 to 2011. The NIS is a stratified, survey-weighted 20% sample of all US hospitals provided by the Healthcare Cost and Utilization Project of the Agency for Healthcare Quality Research [11]. The NIS contains data on procedures, comorbid conditions, insurance status, and demographic characteristics. It also contains certain hospital characteristics (size, teaching status, ownership, rural/urban
Hospital Volume and Characteristics
Volume cutoffs were set at less than 21, 21 to 40, 40 to 78, and more than 78 total lung resections per year. Comparing VHV to LV hospitals, volume was seen to be associated with hospital size, teaching status, and urban location. No clear association between hospital region and volume was observed.
Patient Demographics and Characteristics
Patient demographic and clinical characteristics are shown in Table 1. Patients in VHV hospitals differed from those in LV hospitals. They were younger (age less than 60 years, 31.7% versus 26.9%),
Comment
Improving value in surgery will require innovative strategies to match patients to hospitals to improve outcomes and decrease cost. In this study, we evaluated potential referral strategies for patients undergoing elective lung surgery. We found that both elderly patients and high-risk patients were associated with a significantly greater volume-mortality relationship as compared with younger and lower risk patients. Costs remained approximately equivalent across volume quartiles, and few
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2022, Annals of Thoracic SurgeryCitation Excerpt :The center volume-outcome relationship in thoracic surgery has been extensively studied. It has been well established that higher center volume is associated with superior postoperative outcomes,3,10,11 and this association was similarly seen in our study. There are several possible explanations for the outcome difference between high- and low-volume centers.
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2020, Annals of Thoracic SurgeryCitation Excerpt :Moreover, measures such as the Leapfrog Take the Volume Pledge have proposed to restrict complex surgical procedures to hospitals that meet minimum volume standards.9 Studies of such a relationship in lung resections, however, have yielded conflicting results.10,11,13 Nearly 20 years ago, Birkmeyer and colleagues5 used the Medicare database and found a greater inhospital mortality rate for lung resections performed at low volume centers.