Background Among patients who have undergone high-risk operationsfor cancer, postoperative mortality rates are often lower athospitals where more of these procedures are performed. We undertooka population-based study to estimate the extent to which thenumber of procedures performed at a hospital (hospital volume)is associated with survival after resection for lung cancer.
Methods We studied patients 65 years old or older who receiveda diagnosis of stage I, II, or IIIA non–small-cell lungcancer between 1985 and 1996, resided in 1 of the 10 study areascovered by the Surveillance, Epidemiology, and End Results Program,and underwent surgery at a hospital that participates in theNationwide Inpatient Sample (2118 patients and 76 hospitals).
Results The volume of procedures at the hospital was positivelyassociated with the survival of patients (P<0.001). Fiveyears after surgery, 44 percent of patients who underwent operationsat the hospitals with the highest volume were alive, as comparedwith 33 percent of those who underwent operations at the hospitalswith the lowest volume. Patients at the highest-volume hospitalsalso had lower rates of postoperative complications (20 percentvs. 44 percent) and lower 30-day mortality (3 percent vs. 6percent) than those at the lowest-volume hospitals.
Conclusions Patients who undergo resection for lung cancer athospitals that perform large numbers of such procedures arelikely to survive longer than patients who have such surgeryat hospitals with a low volume of lung-resection procedures.
Source Information
From the Health Outcomes Research Group, the Departments of Epidemiology and Biostatistics (P.B.B., L.D.C., D.S., S.E.G., C.B.B.), Medicine (P.B.B., D.S.), and Surgery (R.J.D.), Memorial Sloan-Kettering Cancer Center, New York.
Address reprint requests to Dr. Bach at the Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Box 221, New York, NY 10021.
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