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Community Size and Lung Cancer Resection Outcomes: Studying The Society of Thoracic Surgeons Database.

Publication ,  Journal Article
Melvan, JN; Khullar, O; Vemulapalli, S; Kosinski, AS; Pickens, A; Force, SD; Zhang, S; Sancheti, MS
Published in: Ann Thorac Surg
October 2021

BACKGROUND: Socioeconomic factors play key roles in surgical outcomes. Socioeconomic data within The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTSD) are limited. Therefore, we utilized community size as a surrogate to understand socioeconomic differences in lung cancer resection outcomes. METHODS: We retrospectively reviewed all lung cancer resections from January 2012 to January 2017 in the STS GTSD. This captured 68,722 patients from 286 centers nationwide. We then linked patient zip codes with 2013 Rural-Urban Continuum Codes to understand the association between community size and postoperative outcomes. Demographic and clinical variables were evaluated for relationships with 30-day mortality, major morbidity, and readmission. RESULTS: Zip codes were included in 47.2% of patients. Zip-coded patients were older, were more comorbid, had less advanced disease, and were more commonly treated with minimally invasive approaches than were those without zip code classification. For geocoded patients, multivariable analyses demonstrated that sex, insurance payor, and hospital region were associated with all 3 major endpoints. Community size, based on Rural-Urban Continuum Codes coding, was not associated with any primary endpoint. Invasive mediastinal staging was related to morbidity, greater pathological stage predicted mortality, and worsened clinical stage was associated with readmission. More invasive surgery and greater extent of lung resection were associated with all primary endpoints. CONCLUSIONS: Incomplete data capture can promote selection bias within the STS GTSD and skew outcomes reporting. Moreover, community size is an insufficient surrogate, compared with sex, insurance payor, hospital region, for understanding socioeconomic differences in lung cancer resection outcomes.

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Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

October 2021

Volume

112

Issue

4

Start / End Page

1076 / 1082

Location

Netherlands

Related Subject Headings

  • United States
  • Treatment Outcome
  • Thoracic Surgery
  • Socioeconomic Factors
  • Societies, Medical
  • Retrospective Studies
  • Respiratory System
  • Residence Characteristics
  • Pneumonectomy
  • Middle Aged
 

Citation

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Melvan, J. N., Khullar, O., Vemulapalli, S., Kosinski, A. S., Pickens, A., Force, S. D., … Sancheti, M. S. (2021). Community Size and Lung Cancer Resection Outcomes: Studying The Society of Thoracic Surgeons Database. Ann Thorac Surg, 112(4), 1076–1082. https://doi.org/10.1016/j.athoracsur.2020.08.076
Melvan, John Nicholas, Onkar Khullar, Sreekanth Vemulapalli, Andrzej S. Kosinski, Allan Pickens, Seth D. Force, Shuaiqi Zhang, and Manu S. Sancheti. “Community Size and Lung Cancer Resection Outcomes: Studying The Society of Thoracic Surgeons Database.Ann Thorac Surg 112, no. 4 (October 2021): 1076–82. https://doi.org/10.1016/j.athoracsur.2020.08.076.
Melvan JN, Khullar O, Vemulapalli S, Kosinski AS, Pickens A, Force SD, et al. Community Size and Lung Cancer Resection Outcomes: Studying The Society of Thoracic Surgeons Database. Ann Thorac Surg. 2021 Oct;112(4):1076–82.
Melvan, John Nicholas, et al. “Community Size and Lung Cancer Resection Outcomes: Studying The Society of Thoracic Surgeons Database.Ann Thorac Surg, vol. 112, no. 4, Oct. 2021, pp. 1076–82. Pubmed, doi:10.1016/j.athoracsur.2020.08.076.
Melvan JN, Khullar O, Vemulapalli S, Kosinski AS, Pickens A, Force SD, Zhang S, Sancheti MS. Community Size and Lung Cancer Resection Outcomes: Studying The Society of Thoracic Surgeons Database. Ann Thorac Surg. 2021 Oct;112(4):1076–1082.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

October 2021

Volume

112

Issue

4

Start / End Page

1076 / 1082

Location

Netherlands

Related Subject Headings

  • United States
  • Treatment Outcome
  • Thoracic Surgery
  • Socioeconomic Factors
  • Societies, Medical
  • Retrospective Studies
  • Respiratory System
  • Residence Characteristics
  • Pneumonectomy
  • Middle Aged