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Comprehensive value implications of surgeon volume for lung cancer surgery: Use of an analytic framework within a regional health system
Journal article   Open access   Peer reviewed

Comprehensive value implications of surgeon volume for lung cancer surgery: Use of an analytic framework within a regional health system

Conor M. Maxwell, Akash M. Bhat, Samantha J. Falls, Matthew Bigbee, Yue Yin, Sricharan Chalikonda, David L. Bartlett, Hiran C. Fernando and Casey J. Allen
JTCVS open, v 17, pp 286-294
01 Feb 2024
DOI: https://doi.org/10.1016/j.xjon.2023.11.010
PMID: 38420536
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1016/j.xjon.2023.11.010View
Published, Version of Record (VoR) Open

Abstract

health care costs outcomes surgeon volume value Lung Cancer
We used a framework to assess the value implications of thoracic surgeon operative volume within an 8-hospital health system. Surgical cases for non–small cell lung cancer were assessed from March 2015 to March 2021. High-volume (HV) surgeons performed >25 pulmonary resections annually. Metrics include length of stay, infection rates, 30-day readmission, in-hospital mortality, median 30-day charges and direct costs, and 3-year recurrence-free and overall survival. Multivariate regression-based propensity scores matched patients between groups. Metrics were graphed on radar charts to conceptualize total value. All 638 lung resections were performed by 12 surgeons across 6 hospitals. Two HV surgeons performed 51% (n = 324) of operations, and 10 low-volume surgeons performed 49% (n = 314). Median follow-up was 28.8 months (14.0-42.3 months). Lobectomy was performed in 71% (n = 450) of cases. HV surgeons performed more segmentectomies (33% [n = 107] vs 3% [n = 8]; P < .001). Patients of HV surgeons had a lower length of stay (3 [2-4] vs 5 [3-7]; P < .001) and infection rates (0.6% [n = 1] vs 4% [n = 7]; P = .03). Low-volume and HV surgeons had similar 30-day readmission rates (14% [n = 23] vs 7% [n = 12]; P = .12), in-hospital mortality (0% [n = 0] vs 0.6% [n = 1]; P = .33), and oncologic outcomes; 3-year recurrence-free survival was 95% versus 91%; P = .44, and 3-year overall survival was 94% versus 90%; P = 0. Charges were reduced by 28%, and direct costs were reduced by 23% (both P < .001) in the HV cohort. HV surgeons provide comprehensive value across a health system. This multidomain framework can be used to help drive oncologic care decisions within a health system. [Display omitted]

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Collaboration types
Domestic collaboration
Web of Science research areas
Cardiac & Cardiovascular Systems
Respiratory System
Surgery
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