Tennessee Valley Healthcare System, Nashville.
Vanderbilt University Medical Center, Nashville, Tennessee.
JAMA Surg. 2019 Jun 1;154(6):524-529. doi: 10.1001/jamasurg.2019.0035.
Minimally invasive lobectomy for early-stage lung cancer has become more prevalent. Video-assisted thoracoscopic surgery has lower rates of morbidity, better long-term survival, and equivalent oncologic outcomes compared with thoracotomy. However, little has been published on the use and outcomes of video-assisted thoracoscopic surgery within Veterans Affairs. There is a public assumption that the the Veterans Affairs is slow to adopt new procedures and technologies.
To determine the uptake of video-assisted thoracoscopic surgery within the Veterans Affairs for patients with known or suspected lung cancer.
DESIGN, SETTING, AND PARTICIPANTS: In this retrospective cohort study of national Veterans Affairs Corporate Data Warehouse data from January 2002 to December 2015, a total of 11 004 veterans underwent lung resection for known or suspected lung cancer. Data were analyzed from March to November 2018.
Open or video-assisted thoracoscopic lobectomy or wedge resection.
Patient demographic characteristics and procedure and diagnosis International Classification of Diseases, Ninth Revision codes were abstracted from Corporate Data Warehouse data.
Of the 11 004 included veterans, 10 587 (96.2%) were male, and the median (interquartile range) age was 66.0 (61.0-72.0) years. Of 11 004 included procedures, 8526 (77.5%) were lobectomies and 2478 (22.5%) were wedge resections. The proportion of video-assisted thoracoscopic lung resections increased steadily from 15.6% in 2002 to 50.6% in 2015. Video-assisted thoracoscopic surgery use by Veterans Integrated Service Networks ranged from 0% to 81.7%, and higher Veterans Integrated Service Network volume was correlated with higher video-assisted thoracoscopic surgery use (Pearson r = 0.35; 95% CI, 0.15-0.52; P < .001). Video-assisted thoracoscopic surgery use and rate of uptake varied widely across Veteran Affairs regions (P < .001 by Wilcoxon signed rank test).
Paralleling academic hospitals, most lung resections are now performed in the Veterans Affairs using video-assisted thoracoscopic surgery. More research is needed to identify reasons behind the heterogeneous uptake of video-assisted thoracoscopic surgery across Veterans Affairs regions.
对于早期肺癌，微创肺叶切除术已越来越普遍。与开胸手术相比，电视辅助胸腔镜手术的发病率更低，长期生存率更高，且肿瘤学效果相当。然而，退伍军人事务部（Veterans Affairs）内使用和结果方面的相关报道却很少。人们普遍认为，退伍军人事务部在采用新程序和技术方面行动迟缓。
确定退伍军人事务部（Veterans Affairs）内针对已知或疑似肺癌患者使用电视辅助胸腔镜手术的情况。
设计、地点和参与者：这是一项全国退伍军人事务部（Veterans Affairs）企业数据仓库数据的回顾性队列研究，时间为 2002 年 1 月至 2015 年 12 月，共有 11004 名退伍军人因已知或疑似肺癌接受了肺切除术。数据于 2018 年 3 月至 11 月进行分析。
开胸或电视辅助胸腔镜肺叶切除术或楔形切除术。
从企业数据仓库数据中提取患者人口统计学特征和程序及诊断国际疾病分类第九版（International Classification of Diseases, Ninth Revision）代码。
在纳入的 11004 名退伍军人中，10587 名（96.2%）为男性，中位（四分位距）年龄为 66.0（61.0-72.0）岁。在纳入的 11004 项手术中，8526 项（77.5%）为肺叶切除术，2478 项（22.5%）为楔形切除术。电视辅助胸腔镜肺切除术的比例从 2002 年的 15.6%稳步上升到 2015 年的 50.6%。退伍军人综合服务网络（Veterans Integrated Service Networks）的使用范围从 0%到 81.7%，退伍军人综合服务网络的使用量与电视辅助胸腔镜手术的使用量呈正相关（Pearson r=0.35；95%CI，0.15-0.52；P<0.001）。退伍军人事务部（Veterans Affairs）各地区的电视辅助胸腔镜手术使用率和吸收率差异很大（Wilcoxon 符号秩检验，P<0.001）。
与学术医院类似，退伍军人事务部（Veterans Affairs）内的大多数肺切除术现在都采用电视辅助胸腔镜手术进行。需要进一步研究以确定退伍军人事务部（Veterans Affairs）各地区电视辅助胸腔镜手术吸收率不同的原因。
