br Top Tier br Ranked Middle br Bottom br Mortality
Hospital ranking variation over the course of 1 year.
Mortality estimates after 90 days appear to be a threshold after which there is less variability in hospital ranking and should be considered as an alternative quality metric in lung cancer surgery.
Thirty-day mortality is not the best metric to compare outcomes or facilitate risk–benefit dis-cussions because it SCH-772984 underestimates death after lung resection. Evaluation of facility ranking shows 50% variation in the top facilities by 90 days. Quality improvement projects and ranking algorithms need to incorporate 90-day mortality data to obtain a more accurate under-standing of postoperative mortality.
See Commentary on page 579.
Lung cancer is the most common cause of death by malig-nancy in the United States and the world.1 Despite expand-ing therapeutic options, the 5-year overall survival for patients with non–small cell lung cancer (NSCLC) remains <25%.2 Surgery is a mainstay of therapy for most patients
From the aDepartment of Surgery and bDivision of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC.
Funded by the Duke University Hospital Department of Surgery. Dr Mulvihill is sup-ported by the National Heart, Lung, and Blood Institute (No. F32HL132460-02).
Read at the 98th Annual Meeting of The American Association for Thoracic Sur-gery, San Diego, California, April 28-May 1, 2018.
Address for reprints: Carrie B. Moore, MD, PhD, Department of Surgery, Duke Uni-versity Medical Center, 2301 Erwin Rd, Durham, NC 27710 (E-mail: carrie.c. [email protected]).
with curable NSCLC. Knowledge of surgery-associated mortality rates and hospital rankings is not only important to improving oncology health care delivery, but also to pa-tients and third-party payers.
Cardiothoracic surgeons have participated in voluntary outcomes reporting for decades in the Society of Thoracic Surgeons (STS) database.3 In comparison with national measures, participation in a general thoracic database has been shown to be associated with decreased mortality and
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570 The Journal of Thoracic and Cardiovascular Surgery c August 2019
Moore et al Thoracic: Lung Cancer
Abbreviations and Acronyms
NCDB ¼ National Cancer Database
NSCLC ¼ non–small cell lung cancer
STS ¼ Society of Thoracic Surgeons
length of hospitalization.4 To ensure highest quality of care and develop plans for improvement, Nuclear lamina is critical to measure and compare outcomes at each level of therapy for thoracic oncology patients using national databases.
Thoracic surgeons are often assessed and ranked by 30-day operative mortality, which is unlikely to be the most accurate measure of quality given the complexity of lung cancer resec-tion and risk of complications beyond 30 days. Several studies of patients after pulmonary resection and esophagec-tomy have indicated that the mortality rate after these opera-tions doubles at 90 days compared with 30-day mortality.5-7 Although 30-day mortality was originally introduced to compare cancer centers on immediate morbidity associated with surgical resection, it is likely that longer assessment of outcomes may be important due to the complexity of the operation and longer oncologic survival times. Therefore, the paradigm of accepting 30-day mortality rates as the only measure of quality should continue to be challenged un-til it is more broadly changed.
In this study, the National Cancer Database (NCDB) was used to examine factors associated with 30-day and 90-day mortality after pulmonary resection for NSCLC. A second-ary analysis was performed to compare postoperative mor-tality across centers using a mixed-model approach at 30-day intervals through 1 year after surgery.
The NCDB is a joint project of the Commission on Cancer of the Amer-ican College of Surgeons and the American Cancer Society. Data within NCDB are collected from more than 1500 Commission on Cancer-accredited facilities and the NCDB contains more than 34 million historical records. These data can be used to analyze and track patients with malig-nancies from diagnosis through treatment to outcome. In general, NCDB captures more than 70% of newly diagnosed cancer cases in the United States.8 The 2014 participant user file includes patients diagnosed between 2004 and 2014, and includes survival information for patients diagnosed through 2013.