ArticleThe Annals of thoracic surgery2019
Survival Before and After Direct Surgical Quality Feedback in a Population-Based Lung Cancer Cohort.
Article in The Annals of thoracic surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 2 of them syntheses that pooled it.
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Who cites it
6 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Quality improvement interventions in surgical oncology: systematic review of international studies.BJS open · 2026Pooled it
- Survival After Mediastinal Node Dissection, Systematic Sampling, or Neither for Early Stage NSCLC.Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer · 2020Pooled it
- Assessment of textbook outcome after lobectomy for early-stage non-small cell lung cancer in a Korean institution: A retrospective study.Thoracic cancer · 2022Article
- Comparative Effectiveness of a Lymph Node Collection Kit Versus Heightened Awareness on Lung Cancer Surgery Quality and Outcomes.Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer · 2021Article
- Closing the gap: Contribution of surgical best practices to outcome differences between high- and low-volume centers for lung cancer resection.Cancer medicine · 2020Article
- Beyond Margin Status: Population-Based Validation of the Proposed International Association for the Study of Lung Cancer Residual Tumor Classification Recategorization.Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer · 2020Article
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19 authors.
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Abstract
backgroundSurgical resection is the main curative modality for non-small cell lung cancer (NSCLC), but variation in the quality of care contributes to suboptimal survival rates. Improving surgical outcomes by eliminating quality deficits is a key strategy for improving population-level lung cancer survival. We evaluated the long-term survival effect of providing direct feedback on institutional performance in a population-based cohort.
methodsThe Mid-South Quality of Surgical Resection cohort includes all NSCLC resections at 11 hospitals in four contiguous Dartmouth Hospital Referral Regions in Arkansas, Mississippi, and Tennessee. We evaluated resections from 2004 to 2013, before and after onset of a benchmarked performance feedback campaign to surgery and pathology teams in 2009.
resultsWe evaluated 2,206 patients: 56% preintervention (pre-era) and 44% postintervention (post-era). Preoperative positron emission tomography/computed tomography (46% vs 82%, p < 0.0001), brain scans (6% vs 21%, p < 0.0001), and bronchoscopy (8% vs 27%, p < 0.0001) were more frequently used in the post-era. Patients had 5-year survival of 47% (44% to 50%) in the pre-era compared with 53% (50% to 56%) in the post-era (p = 0.0028). The post-era had an adjusted hazard ratio of 0.85 (95% confidence interval [CI], 0.75 to 0.97; p = 0.0158) compared with the pre-era. This differed by extent of resection (p = 0.0113): compared with the pre-era, the post-era adjusted hazard ratio was 0.49 (95% CI, 0.33 to 0.72) in pneumonectomy, 0.91 (95% CI, 0.79 to 1.05) in lobectomy/bilobectomy, and 0.85 (95% CI, 0.63 to 1.15) in segmentectomy/wedge resections.
conclusionsOverall survival after surgical resection improved significantly in a high lung cancer mortality region of the United States. Reasons may include better selection of patients for pneumonectomy and more thorough staging.
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