Geraci Travis, Baratta Vanessa, Young John, Milman Steven, Dunican Ann-Marie, Jones Richard N, Ng Thomas
Department of Surgery, Alpert Medical School of Brown University, Providence, Rhode Island.
Department of Surgery, Alpert Medical School of Brown University, Providence, Rhode Island; Veterans Administration Medical Center, Providence, Rhode Island.
Ann Thorac Surg. 2017 Jun;103(6):1715-1722. doi: 10.1016/j.athoracsur.2016.12.040. Epub 2017 Mar 24.
Hospital and surgeon volume each have an association with postoperative outcomes. The volume of lung cancer surgery at our Veterans Administration Medical Center (VAMC) is lower than at our academic medical center (AMC). We compared the outcomes after lobectomy at VAMC versus AMC to identify specific areas of clinical care requiring quality improvement.
To keep surgeon experience constant, data were derived from a prospective database from a single surgeon. Included were all male patients undergoing lobectomy for non-small cell lung cancer. Postoperative morbidity, mortality, and overall survival were compared after propensity score matching.
From 2004 to 2013, 419 patients were evaluated (338 AMC, 81 VAMC). Outcomes comparison after propensity score matching of 81 AMC patients with 81 VAMC patients found a higher rate of major complications (12% versus 27%, p = 0.02) and longer hospital stay (median 6.0 versus 7.5 days, p < 0.001) for VAMC, but no difference in 90-day mortality (AMC 5% versus VAMC 6%, p > 0.99). Pneumonia was the specific complication found to be higher at VAMC (11% versus AMC 1.2%, p = 0.01). There was no difference in 5-year overall survival for stage I disease (AMC 68% versus VAMC 69%, p = 0.95).
Keeping surgeon experience constant, and after adjusting for patient factors, the rate of major complication after lobectomy is higher at VAMC. The difference is largely attributable to a higher rate of postoperative pneumonia at VAMC. Complications after pulmonary resection at VAMC could be reduced by implementing quality improvement initiatives aimed at reducing the rate of postoperative pneumonia.
医院规模和外科医生手术量均与术后结果相关。我们退伍军人管理局医疗中心（VAMC）的肺癌手术量低于学术医疗中心（AMC）。我们比较了VAMC和AMC肺叶切除术后的结果，以确定需要改进质量的具体临床护理领域。
为保持外科医生经验一致，数据来自一位外科医生的前瞻性数据库。纳入所有接受非小细胞肺癌肺叶切除术的男性患者。在倾向评分匹配后比较术后发病率、死亡率和总生存率。
2004年至2013年，共评估了419例患者（338例在AMC，81例在VAMC）。81例AMC患者与81例VAMC患者倾向评分匹配后的结果比较发现，VAMC的主要并发症发生率更高（12%对27%，p = 0.02），住院时间更长（中位数6.0天对7.5天，p < 0.001），但90天死亡率无差异（AMC为5%，VAMC为6%，p > 0.99）。发现VAMC的肺炎这一特定并发症发生率更高（11%对AMC的1.2%，p = 0.01）。I期疾病的5年总生存率无差异（AMC为68%，VAMC为69%，p = 0.95）。
在保持外科医生经验一致并调整患者因素后，VAMC肺叶切除术后的主要并发症发生率更高。差异主要归因于VAMC术后肺炎发生率更高。通过实施旨在降低术后肺炎发生率的质量改进措施，可以降低VAMC肺切除术后的并发症。
