Risk-Adjusted Margin Positivity Rate as a Surgical Quality Metric for Non-Small Cell Lung Cancer

被引:13
|
作者
Lin, Chun Chieh
Smeltzer, Matthew P.
Jemal, Ahmedin
Osarogiagbon, Raymond U.
机构
[1] Amer Canc Soc, Surveillance & Hlth Serv Res, Atlanta, GA 30329 USA
[2] Univ Memphis, Dept Epidemiol & Biostat, Sch Publ Hlth, Memphis, TN 38152 USA
[3] Baptist Canc Ctr, Multidisciplinary Thorac Oncol Program, Memphis, TN USA
来源
ANNALS OF THORACIC SURGERY | 2017年 / 104卷 / 04期
关键词
LONG-TERM SURVIVAL; SURGEON SPECIALTY; THORACIC-SURGERY; RESIDUAL DISEASE; HOSPITAL VOLUME; MORTALITY; RESECTION; OUTCOMES;
D O I
10.1016/j.athoracsur.2017.04.033
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. Incomplete lung cancer resection connotes poor prognosis; the incidence varies with patient demographic, clinical, and institutional factors. We sought to develop a valid, survival impactful, facility-based surgical quality metric that adjusts for related patient demographic and clinical characteristics. Methods. Facilities performing resections for patients diagnosed with stage I to IIIA non-small cell lung cancer in the National Cancer Data Base between 2004 and 2011 were identified. Multivariate logistic regression modeling was used to estimate the expected number of margin-positive cases by adjusting for patient risk mix and calculate the observed-to-expected ratio for each facility. Facilities were categorized as outperformers (observed-to-expected ratio less than 1, p < 0.05), non-outliers (p > 0.05), and underperformers (observed-to-expected ratio greater than 1, p < 0.05); and their characteristics across performance categories were compared by chi(2) tests. Multivariate Cox proportional hazard analyses were conducted, adjusting for patient demographic and clinical characteristics. Results. A total of 96,324 patients underwent surgery at 809 facilities. The overall observed margin-positive rate was 4.4%. Sixty-one facilities (8%) were outperformers, 644 (80%) were nonoutliers, and 104 (13%) were under-performers. One third (36%) of National Cancer Institute-designated facilities, 13% of academic comprehensive cancer programs, 5% of comprehensive community cancer programs, and 13% of "other" facilities achieved outperforming status but no community cancer programs did. Interestingly, 9% of National Cancer Institute-designated facilities and 11% of academic comprehensive cancer program facilities were underperformers. Adjusting for patient demographic and clinical characteristics, outperformers had a 5-year all-cause hazard ratio of 0.88 (95% confidence interval: 0.85 to 0.91, p < 0.0001) compared with nonoutliers, and 0.80 (95% confidence interval: 0.77 to 0.84, p < 0.0001) compared with underperformers. Conclusions. Facility performance in lung cancer surgery can be captured by the risk-adjusted margin-positivity rate, potentially providing a valid quality improvement metric. (C) 2017 by The Society of Thoracic Surgeons
引用
收藏
页码:1161 / 1170
页数:10
相关论文
共 50 条
  • [1] Risk-adjusted margin positivity (RAMP) rate as a surgical quality metric for non-small-cell lung cancer (NSCLC).
    Lin, Chun Chieh
    Smeltzer, Matthew
    Jemal, Ahmedin
    Osarogiagbon, Raymond U.
    [J]. JOURNAL OF CLINICAL ONCOLOGY, 2016, 34 (15)
  • [2] Risk-Adjusted Margin Positivity (RAMP) Rate as a Surgical Quality Metric for Non-Small-Cell Lung Cancer in the US National Cancer Data Base (NCDB)
    Lin, Chun Chieh
    Smeltzer, Matthew P.
    Yu, Xinhua
    Osarogiagbon, Raymond U.
    Jemal, Ahmedin
    [J]. JOURNAL OF THORACIC ONCOLOGY, 2015, 10 (09) : S334 - S334
  • [3] Risk-Adjusted Pathologic Margin Positivity Rate As a Quality Indicator in Rectal Cancer Surgery
    Massarweh, Nader N.
    Hu, Chung-Yuan
    You, Y. Nancy
    Bednarski, Brian K.
    Rodriguez-Bigas, Miguel A.
    Skibber, John M.
    Cantor, Scott B.
    Cormier, Janice N.
    Feig, Barry W.
    Chang, George J.
    [J]. JOURNAL OF CLINICAL ONCOLOGY, 2014, 32 (27) : 2967 - 2974
  • [4] Risk-Adjusted Pathologic Margin Positivity Rate: A Problematic Quality Indicator
    Turner, Natalie H.
    Wong, Hui-Li
    Gibbs, Peter
    [J]. JOURNAL OF CLINICAL ONCOLOGY, 2015, 33 (12) : 1410 - +
  • [5] RISK FACTORS OF MARGIN RECURRENCE IN SUBLOBAR RESECTION OF NON-SMALL CELL LUNG CANCER
    Nagata, Masashi
    Ohde, Yasuhisa
    Miyata, Naoko
    Kojima, Hideaki
    Kozu, Yoshiki
    Yamatani, Chihiro
    Yamauchi, Yoshikane
    Maniwa, Tomohiro
    Takahashi, Shoji
    Isaka, Mitsuhiro
    Nakajima, Takashi
    [J]. JOURNAL OF THORACIC ONCOLOGY, 2012, 7 (11) : S475 - S475
  • [6] Surgical Staging for Non-Small Cell Lung Cancer
    Gamliel, Ziv
    [J]. SURGICAL ONCOLOGY CLINICS OF NORTH AMERICA, 2011, 20 (04) : 691 - +
  • [7] Surgical treatment of non-small cell lung cancer
    De Leyn, P
    Decker, G
    [J]. REVUE DES MALADIES RESPIRATOIRES, 2004, 21 (05) : 971 - 982
  • [8] Clinical and surgical staging of non-small cell lung cancer
    Deslauriers, J
    Grégoire, J
    [J]. CHEST, 2000, 117 (04) : 96S - 103S
  • [9] Non-small cell lung cancer: the limits of surgical resection
    Grunenwald, D.
    [J]. REVUE DES MALADIES RESPIRATOIRES, 2007, 24 (08) : S211 - S215
  • [10] Advances in Surgical Techniques in Non-Small Cell Lung Cancer
    Kim, Anthony W.
    Detterbeck, Frank C.
    [J]. SEMINARS IN RESPIRATORY AND CRITICAL CARE MEDICINE, 2013, 34 (06) : 855 - 865