Abdelsattar Zaid M, Shen K Robert, Yendamuri Sai, Cassivi Stephen, Nichols Francis C, Wigle Dennis A, Allen Mark S, Blackmon Shanda H
Division of Thoracic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, New York.
Ann Thorac Surg. 2017 Nov;104(5):1656-1664. doi: 10.1016/j.athoracsur.2017.05.086. Epub 2017 Sep 19.
The current national trends, practice patterns, and outcomes after sleeve resection compared with pneumonectomy in the United States are not known. In addition, whether hospital sleeve-to-pneumonectomy (S:P) ratios are a valid marker of hospital quality is unclear. We describe practice patterns and evaluate the utility of the S:P ratio.
We identified all patients (N = 23,964) undergoing sleeve resection (n = 1,713) or pneumonectomy (n = 22,251) in the National Cancer Data Base between 1998 and 2012 at 644 hospitals. We used propensity score matching to compare short-term outcomes and overall survival between pneumonectomy and sleeve resection. We grouped hospitals into S:P ratio quintiles and used multilevel modeling to analyze hospital-level outcomes.
There has been a 1% yearly increase in sleeve resection rates, with wide variation in hospital S:P ratios (middle quintile, 1:12; range, 1:38 to 1:3). After propensity score matching, differences in age, clinical T and N stage, and the incidence of main bronchus tumors were negligible among other variables. Sleeve resections were associated with lower 30-day (1.6% vs 5.9%; p < 0.001) and 90-day mortality (4% vs 9.4%; p < 0.001) and improved overall survival. Hospitals with higher S:P ratios were not associated with better risk-adjusted 30-day (7.2% vs 7.4%; p = 0.244) or 90-day mortality (11.9% vs 12.2%; p = 0.308) or same-hospital readmission rates (3.7% vs 4.3%; p = 0.523).
Compared with pneumonectomy, sleeve resections are associated with improved short-term outcomes and improved overall survival. However, hospital S:P ratios were not associated with better risk-adjusted outcomes and thus may not be a valid quality measure.
在美国，目前与肺切除术相比，肺叶袖状切除术的全国趋势、实践模式及术后结果尚不清楚。此外，医院肺叶袖状切除术与肺切除术（S:P）的比例是否是衡量医院质量的有效指标也不明确。我们描述了实践模式并评估了S:P比例的效用。
我们在国家癌症数据库中识别了1998年至2012年间在644家医院接受肺叶袖状切除术（n = 1,713）或肺切除术（n = 22,251）的所有患者（N = 23,964）。我们使用倾向评分匹配法比较肺切除术和肺叶袖状切除术之间的短期结果和总生存率。我们将医院分为S:P比例五分位数组，并使用多水平模型分析医院层面的结果。
肺叶袖状切除术的发生率每年增加1%，医院的S:P比例差异很大（中间五分位数为1:12；范围为1:38至1:3）。在倾向评分匹配后，年龄、临床T和N分期以及主支气管肿瘤的发生率在其他变量中差异可忽略不计。肺叶袖状切除术与较低的30天（1.6%对5.9% ; p < 0.001）和90天死亡率（4%对9.4% ; p < 0.001）以及改善的总生存率相关。S:P比例较高的医院与风险调整后的30天（7.2%对7.4% ; p = 0.244）或90天死亡率（11.9%对12.2% ; p = 0.308）或同院再入院率（3.7%对4.3% ; p = 0.523）较好无关。
与肺切除术相比，肺叶袖状切除术与改善的短期结果和总生存率相关。然而，医院的S:P比例与更好的风险调整后结果无关，因此可能不是一个有效的质量指标。
