Association of Hospital Surgical Volume With Outcomes in Resected Stage I Non-Small Cell Lung Cancer.

INTRODUCTION

Prior research examining the volume-outcome relationship for lung cancer resection has focused primarily on non-Veteran populations treated across diverse healthcare systems. This study aimed to evaluate the relationship between hospital surgical volume and postoperative outcomes for early-stage non-small cell lung cancer (NSCLC) in Veteran and non-Veteran populations in the United States.

METHODS

We conducted a retrospective cohort study of patients diagnosed with stage I NSCLC who underwent surgical resection in the Veterans Health Administration (VHA) from 2007-2019 and National Cancer Database (NCDB) from 2010-2019. Hospitals were categorized based on their annual volume of lung cancer resections. Multivariable regression models were used to evaluate the association between hospital surgical volume and postoperative outcomes, adjusting for relevant patient-, tumor-, and treatment-related covariates.

RESULTS

In total, 11,623 patients from the VHA and 125,213 patients from the NCDB were included. Patients who underwent surgical resection at high-volume VHA hospitals had similar risk-adjusted odds of prolonged hospitalization (adjusted odds ratio [aOR] 0.876, 95% confidence interval [CI] 0.741-1.034), 30-d major complications (aOR 1.146, CI 0.969-1.357), 90-d mortality (aOR 0.899, CI 0.666-1.215), cumulative incidence of recurrence (adjusted hazard ratio [aHR] 1.039, CI 0.923-1.169), and overall survival (aHR for death 1.060, CI 0.990-1.136), compared with those treated at low-volume VHA hospitals. In contrast, among patients within the NCDB, surgical treatment at high-volume Commission on Cancer (CoC)-accredited hospitals was associated with lower risk-adjusted odds of prolonged hospitalization (aOR 0.643, CI 0.588-0.703) and 90-d mortality (aOR 0.755, CI 0.655-0.857), as well as improved overall survival (aHR for death 0.893, CI 0.860-0.929), compared with treatment at low-volume CoC-accredited hospitals.

CONCLUSIONS

The volume-outcome relationship seen in the surgical treatment of early-stage NSCLC at CoC-accredited hospitals was not observed within the VHA system. The VHA's integrated healthcare model and academic partnerships may help mitigate volume-related outcome differences following surgery for early-stage lung cancer.