Does one size fit all? An evaluation of the 2018 Leapfrog Group minimal hospital and surgeon volume thresholds for lung surgery

James M. Clark, David T. Cooke, David L. Chin, Garth H. Utter, Lisa M. Brown, Miriam Nuño

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: In 2018, the Leapfrog Group set minimum annual lung cancer surgery hospital and surgeon volume thresholds of 40 and 15, respectively. We examined whether outcomes associated with these Leapfrog Group volume thresholds are comparable for patients at the extremes of age and comorbidities. Methods: We assessed lung cancer patients undergoing lobectomy or pneumonectomy in the New York and Florida State Inpatient Databases for 2007 to 2013. Multivariate logit models evaluated in-hospital mortality, complications, and prolonged length of stay. Median surgeon and hospital volumes were compared between “younger-healthier” (age 18-60 years, Elixhauser Comorbidity Index <1) and “older-sicker” patients (age >77 years, Elixhauser Comorbidity Index >3). Results: The 27,841 patients included 13,277 men (48%). The median patient age was 69 years (interquartile range, 61-77), and mortality was 2.1%. Patients treated by both low-volume surgeons (<15 annual cases) and at low-volume hospitals (<40) had the greatest risk of mortality (2.5%), except for the cohort of younger-healthier patients (mortality <2%). Mortality for older-sicker patients was highest for high-volume surgeons (12%), although higher hospital volume was protective. Increasing hospital volume was associated with decreased mortality (odds ratio [OR], 0.997; 95% confidence interval [CI], 0.995-0.998; P =.0103), complications (OR, 0.998; 95% CI, 0.997-0.999; P <.001), and prolonged length of stay (OR, 0.998; 95% CI, 0.997-1.00; P =.01); similarly, higher surgeon volume was associated with decreased mortality (OR, 0.997; 95% CI, 0.99-1.00; P =.03), complications (OR, 0.997; 95% CI, 0.994-1.00; P =.02), and prolonged length of stay (OR, 0.991; 95% CI, 0.986-0.995; P <.01). Conclusions: Hospital volume has a greater effect on morbidity and mortality than surgeon volume especially for older-sicker patients, suggesting that Leapfrog Group volume guidelines should emphasize hospital volume over surgeon volume and may be less relevant for younger-healthier patients.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
StateAccepted/In press - Jan 1 2019

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Lung
Odds Ratio
Confidence Intervals
Mortality
Comorbidity
Length of Stay
Lung Neoplasms
Low-Volume Hospitals
High-Volume Hospitals
Surgeons
Cancer Care Facilities
Pneumonectomy
Hospital Mortality
Inpatients
Logistic Models
Databases
Guidelines
Morbidity

Keywords

  • complications
  • hospital volume
  • length of stay
  • mortality
  • surgeon volume

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{b3f2ea42ac8e4f12a1b5a9a0d7e7d097,
title = "Does one size fit all? An evaluation of the 2018 Leapfrog Group minimal hospital and surgeon volume thresholds for lung surgery",
abstract = "Background: In 2018, the Leapfrog Group set minimum annual lung cancer surgery hospital and surgeon volume thresholds of 40 and 15, respectively. We examined whether outcomes associated with these Leapfrog Group volume thresholds are comparable for patients at the extremes of age and comorbidities. Methods: We assessed lung cancer patients undergoing lobectomy or pneumonectomy in the New York and Florida State Inpatient Databases for 2007 to 2013. Multivariate logit models evaluated in-hospital mortality, complications, and prolonged length of stay. Median surgeon and hospital volumes were compared between “younger-healthier” (age 18-60 years, Elixhauser Comorbidity Index <1) and “older-sicker” patients (age >77 years, Elixhauser Comorbidity Index >3). Results: The 27,841 patients included 13,277 men (48{\%}). The median patient age was 69 years (interquartile range, 61-77), and mortality was 2.1{\%}. Patients treated by both low-volume surgeons (<15 annual cases) and at low-volume hospitals (<40) had the greatest risk of mortality (2.5{\%}), except for the cohort of younger-healthier patients (mortality <2{\%}). Mortality for older-sicker patients was highest for high-volume surgeons (12{\%}), although higher hospital volume was protective. Increasing hospital volume was associated with decreased mortality (odds ratio [OR], 0.997; 95{\%} confidence interval [CI], 0.995-0.998; P =.0103), complications (OR, 0.998; 95{\%} CI, 0.997-0.999; P <.001), and prolonged length of stay (OR, 0.998; 95{\%} CI, 0.997-1.00; P =.01); similarly, higher surgeon volume was associated with decreased mortality (OR, 0.997; 95{\%} CI, 0.99-1.00; P =.03), complications (OR, 0.997; 95{\%} CI, 0.994-1.00; P =.02), and prolonged length of stay (OR, 0.991; 95{\%} CI, 0.986-0.995; P <.01). Conclusions: Hospital volume has a greater effect on morbidity and mortality than surgeon volume especially for older-sicker patients, suggesting that Leapfrog Group volume guidelines should emphasize hospital volume over surgeon volume and may be less relevant for younger-healthier patients.",
keywords = "complications, hospital volume, length of stay, mortality, surgeon volume",
author = "Clark, {James M.} and Cooke, {David T.} and Chin, {David L.} and Utter, {Garth H.} and Brown, {Lisa M.} and Miriam Nu{\~n}o",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jtcvs.2019.09.082",
language = "English (US)",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Does one size fit all? An evaluation of the 2018 Leapfrog Group minimal hospital and surgeon volume thresholds for lung surgery

AU - Clark, James M.

AU - Cooke, David T.

AU - Chin, David L.

AU - Utter, Garth H.

AU - Brown, Lisa M.

AU - Nuño, Miriam

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: In 2018, the Leapfrog Group set minimum annual lung cancer surgery hospital and surgeon volume thresholds of 40 and 15, respectively. We examined whether outcomes associated with these Leapfrog Group volume thresholds are comparable for patients at the extremes of age and comorbidities. Methods: We assessed lung cancer patients undergoing lobectomy or pneumonectomy in the New York and Florida State Inpatient Databases for 2007 to 2013. Multivariate logit models evaluated in-hospital mortality, complications, and prolonged length of stay. Median surgeon and hospital volumes were compared between “younger-healthier” (age 18-60 years, Elixhauser Comorbidity Index <1) and “older-sicker” patients (age >77 years, Elixhauser Comorbidity Index >3). Results: The 27,841 patients included 13,277 men (48%). The median patient age was 69 years (interquartile range, 61-77), and mortality was 2.1%. Patients treated by both low-volume surgeons (<15 annual cases) and at low-volume hospitals (<40) had the greatest risk of mortality (2.5%), except for the cohort of younger-healthier patients (mortality <2%). Mortality for older-sicker patients was highest for high-volume surgeons (12%), although higher hospital volume was protective. Increasing hospital volume was associated with decreased mortality (odds ratio [OR], 0.997; 95% confidence interval [CI], 0.995-0.998; P =.0103), complications (OR, 0.998; 95% CI, 0.997-0.999; P <.001), and prolonged length of stay (OR, 0.998; 95% CI, 0.997-1.00; P =.01); similarly, higher surgeon volume was associated with decreased mortality (OR, 0.997; 95% CI, 0.99-1.00; P =.03), complications (OR, 0.997; 95% CI, 0.994-1.00; P =.02), and prolonged length of stay (OR, 0.991; 95% CI, 0.986-0.995; P <.01). Conclusions: Hospital volume has a greater effect on morbidity and mortality than surgeon volume especially for older-sicker patients, suggesting that Leapfrog Group volume guidelines should emphasize hospital volume over surgeon volume and may be less relevant for younger-healthier patients.

AB - Background: In 2018, the Leapfrog Group set minimum annual lung cancer surgery hospital and surgeon volume thresholds of 40 and 15, respectively. We examined whether outcomes associated with these Leapfrog Group volume thresholds are comparable for patients at the extremes of age and comorbidities. Methods: We assessed lung cancer patients undergoing lobectomy or pneumonectomy in the New York and Florida State Inpatient Databases for 2007 to 2013. Multivariate logit models evaluated in-hospital mortality, complications, and prolonged length of stay. Median surgeon and hospital volumes were compared between “younger-healthier” (age 18-60 years, Elixhauser Comorbidity Index <1) and “older-sicker” patients (age >77 years, Elixhauser Comorbidity Index >3). Results: The 27,841 patients included 13,277 men (48%). The median patient age was 69 years (interquartile range, 61-77), and mortality was 2.1%. Patients treated by both low-volume surgeons (<15 annual cases) and at low-volume hospitals (<40) had the greatest risk of mortality (2.5%), except for the cohort of younger-healthier patients (mortality <2%). Mortality for older-sicker patients was highest for high-volume surgeons (12%), although higher hospital volume was protective. Increasing hospital volume was associated with decreased mortality (odds ratio [OR], 0.997; 95% confidence interval [CI], 0.995-0.998; P =.0103), complications (OR, 0.998; 95% CI, 0.997-0.999; P <.001), and prolonged length of stay (OR, 0.998; 95% CI, 0.997-1.00; P =.01); similarly, higher surgeon volume was associated with decreased mortality (OR, 0.997; 95% CI, 0.99-1.00; P =.03), complications (OR, 0.997; 95% CI, 0.994-1.00; P =.02), and prolonged length of stay (OR, 0.991; 95% CI, 0.986-0.995; P <.01). Conclusions: Hospital volume has a greater effect on morbidity and mortality than surgeon volume especially for older-sicker patients, suggesting that Leapfrog Group volume guidelines should emphasize hospital volume over surgeon volume and may be less relevant for younger-healthier patients.

KW - complications

KW - hospital volume

KW - length of stay

KW - mortality

KW - surgeon volume

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U2 - 10.1016/j.jtcvs.2019.09.082

DO - 10.1016/j.jtcvs.2019.09.082

M3 - Article

C2 - 31740117

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JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

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