Practice Makes Perfect in Lung Cancer Surgery

A new study confirms that as with other surgical procedures, medical centers and individual doctors who perform larger volumes of lung cancer surgery have correspondingly lower mortality rates.

Researchers at Duke University (Durham, NC, USA) analyzed data from the U.S. Nationwide Inpatient Sample--a publicly-available database of hospital admissions dating back 20 years and representing approximately 90% of hospitals in the United States--to examine death rates following three common types of surgery for lung cancer; pneumonectomy, in which the whole lung is removed; lobectomy, in which a third to half of the lung is removed; and segmental resection, in which a smaller portion of the lung is removed. In all, over 130,000 patient data samples were studied. The study results showed that mortality was highest, for all three procedures, at institutions which perform very few of these types of operations. In contrast, hospitals that performed 40 procedures or more per year had the lowest mortality rates. The researchers also found that the mortality in teaching hospitals was slightly lower than in non-teaching institutions. The study, scheduled for publication in the December 2008 edition of the journal Cancer Therapy, was published early online on the journal's website.

"Our study found that hospitals that do higher volumes of these types of surgeries have correspondingly lower mortality rates than those who do fewer of the procedures,” said lead author Andrew Shaw, M.D., an anesthesiologist at Duke. "This has important implications for both patients and doctors; patients should choose a center that does these procedures often, and doctors who are only doing a few of these a year should consider either growing their practices, or focusing their attention on other, less complex, types of surgery.”

"Patients are sometimes wary of having their surgery performed at a teaching institution because they think they may be operated on by an inexperienced trainee and this might lead to a poorer outcome,” Dr. Shaw added. "Actually, it appears that the outcomes at teaching hospitals are no worse than at non-teaching, or private, institutions.”

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