SESSION TITLE: Cardiothoracic Surgery
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 27, 2014 at 07:30 AM - 08:30 AM
PURPOSE: Lobectomy by Video-Assisted Thoracic Surgery (VATS) is associated with decreased morbidity and at least equivalent mortality compared to open lobectomy. We evaluated the trend of VATS lobectomy in the United States using the Nationwide Inpatient Sample (NIS).
METHODS: Patient discharge and hospital data for lobectomies performed for lung cancer recorded in the NIS from 2008-2011 were analyzed. Data are summarized by raw frequency counts with sample-weighted percentages. Logistic regression models were fitted to investigate increases in prevalence of VATS lobectomy over time. We also evaluated the patient and hospital characteristics related to the likelihood of receiving a VATS vs. open lobectomy. Finally we examined the subset of high volume VATS lobectomy hospitals (defined as >20 per year) and the patients treated therein.
RESULTS: In the NIS database from 2008-2011, there were 23,783 lobectomies performed at 1,532 hospitals; 7,180 were VATS. The proportion of VATS procedures increased significantly from 2008 to 2011 (p<0.01) even after adjustment for potential confounding variables (p=0.04). In addition, patients over 75, women, patients with a lower comorbidity score, and patients treated at hospitals with higher overall lobectomy volume were significantly more likely to undergo VATS Lobectomy(p<0.05 for each). Of the 23,783 discharges, 18,535 (77.8%) were performed at a hospital performing at least one VATS procedure per year; similarly, 22.2% of all hospitals did not perform any VATS procedures. High volume VATS lobectomy hospitals are rare and the proportion of them did not increase significantly. Patients who were insured, from higher income areas, or had lower comorbidity scores were more likely to be treated at high volume hospitals (p<0.05 for each).
CONCLUSIONS: The proportion of lobectomies being performed via VATS is significantly increasing. High volume VATS lobectomy hospitals are rare. The proportion of hospitals that are high volume and of patients treated in those hospitals has remained stable. Patient characteristics such as insurance status, income, and comorbidities are predictors of treatment at high volume hospitals. These data highlight the differences in the patient populations seen among hospitals and suggest a potential disparity in access to high volume centers.
CLINICAL IMPLICATIONS: This study suggests that potential disparities exist in this patient population. Awareness will lead to better understanding of barriers to high-quality care.
DISCLOSURE: The following authors have nothing to disclose: Meredith Baker, Sarah Hegarty, Scott Keith, Scott Cowan, Nathaniel Evans
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