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Volume Pledge is Not Associated with Better Short-Term Outcomes After Lung Cancer Resection.

Publication ,  Journal Article
Farjah, F; Grau-Sepulveda, MV; Gaissert, H; Block, M; Grogan, E; Brown, LM; Kosinski, AS; Kozower, BD
Published in: J Clin Oncol
October 20, 2020

PURPOSE: We examined the relationship between short-term outcomes and hospitals and surgeons who met minimum volume thresholds for lung cancer resection based on definitions provided by the Volume Pledge. A secondary aim was to evaluate the volume-outcome relationship to determine alternative thresholds in the event the Volume Pledge was not associated with outcomes. PATIENTS AND METHODS: We conducted a retrospective study (2015-2017) using the Society of Thoracic Surgeons General Thoracic Surgery Database. We used generalized estimating equations that accounted for confounding and clustering to compare outcomes across hospitals and surgeons who did and did not meet the Volume Pledge criteria: ≥ 40 patients per year for hospitals and ≥ 20 patients per year for surgeons. Our secondary aim was to model volume by using restricted cubic splines to determine the association between volume and short-term outcomes. RESULTS: Among 32,183 patients, 465 surgeons, and 209 hospitals, 16,630 patients (52%) received care from both a hospital and surgeon meeting the Volume Pledge criteria. After adjustment, there was no relationship with operative mortality, complications, major morbidity, a major morbidity-mortality composite end point, or failure to rescue. The Volume Pledge group had a 0.5 day (95% CI, 0.2 to 0.7 day) shorter length of stay. Our secondary aim revealed a nonlinear relationship between hospital volume and complications in which intermediate-volume hospitals had the highest risk of complications. Surgeon volume was associated with major morbidity, a major morbidity-mortality composite end point, and length of stay in an inverse linear fashion. Only 8% of surgeons had volumes associated with better outcomes. CONCLUSION: The Volume Pledge was not associated with better outcomes except for a marginally shorter length of stay. A re-examination of volume-outcome relationships for hospitals and surgeons yielded mixed results that did not reveal a practical alternative for volume-based quality improvement efforts.

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Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

October 20, 2020

Volume

38

Issue

30

Start / End Page

3518 / 3527

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgical Oncology
  • Surgeons
  • Retrospective Studies
  • Pulmonary Surgical Procedures
  • Outcome Assessment, Health Care
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Lung Neoplasms
 

Citation

APA
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Farjah, F., Grau-Sepulveda, M. V., Gaissert, H., Block, M., Grogan, E., Brown, L. M., … Kozower, B. D. (2020). Volume Pledge is Not Associated with Better Short-Term Outcomes After Lung Cancer Resection. J Clin Oncol, 38(30), 3518–3527. https://doi.org/10.1200/JCO.20.00329
Farjah, Farhood, Maria V. Grau-Sepulveda, Henning Gaissert, Mark Block, Eric Grogan, Lisa M. Brown, Andrzej S. Kosinski, and Benjamin D. Kozower. “Volume Pledge is Not Associated with Better Short-Term Outcomes After Lung Cancer Resection.J Clin Oncol 38, no. 30 (October 20, 2020): 3518–27. https://doi.org/10.1200/JCO.20.00329.
Farjah F, Grau-Sepulveda MV, Gaissert H, Block M, Grogan E, Brown LM, et al. Volume Pledge is Not Associated with Better Short-Term Outcomes After Lung Cancer Resection. J Clin Oncol. 2020 Oct 20;38(30):3518–27.
Farjah, Farhood, et al. “Volume Pledge is Not Associated with Better Short-Term Outcomes After Lung Cancer Resection.J Clin Oncol, vol. 38, no. 30, Oct. 2020, pp. 3518–27. Pubmed, doi:10.1200/JCO.20.00329.
Farjah F, Grau-Sepulveda MV, Gaissert H, Block M, Grogan E, Brown LM, Kosinski AS, Kozower BD. Volume Pledge is Not Associated with Better Short-Term Outcomes After Lung Cancer Resection. J Clin Oncol. 2020 Oct 20;38(30):3518–3527.

Published In

J Clin Oncol

DOI

EISSN

1527-7755

Publication Date

October 20, 2020

Volume

38

Issue

30

Start / End Page

3518 / 3527

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgical Oncology
  • Surgeons
  • Retrospective Studies
  • Pulmonary Surgical Procedures
  • Outcome Assessment, Health Care
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Lung Neoplasms