Background: The current national trends, practice patterns, and outcomes after sleeve resection compared with pneumonectomy in the United States are not known. In addition, whether hospital sleeve-to-pneumonectomy (S:P) ratios are a valid marker of hospital quality is unclear. We describe practice patterns and evaluate the utility of the S:P ratio.
Methods: We identified all patients (N = 23,964) undergoing sleeve resection (n = 1,713) or pneumonectomy (n = 22,251) in the National Cancer Data Base between 1998 and 2012 at 644 hospitals. We used propensity score matching to compare short-term outcomes and overall survival between pneumonectomy and sleeve resection. We grouped hospitals into S:P ratio quintiles and used multilevel modeling to analyze hospital-level outcomes.
Results: There has been a 1% yearly increase in sleeve resection rates, with wide variation in hospital S:P ratios (middle quintile, 1:12; range, 1:38 to 1:3). After propensity score matching, differences in age, clinical T and N stage, and the incidence of main bronchus tumors were negligible among other variables. Sleeve resections were associated with lower 30-day (1.6% vs 5.9%; p < 0.001) and 90-day mortality (4% vs 9.4%; p < 0.001) and improved overall survival. Hospitals with higher S:P ratios were not associated with better risk-adjusted 30-day (7.2% vs 7.4%; p = 0.244) or 90-day mortality (11.9% vs 12.2%; p = 0.308) or same-hospital readmission rates (3.7% vs 4.3%; p = 0.523).
Conclusions: Compared with pneumonectomy, sleeve resections are associated with improved short-term outcomes and improved overall survival. However, hospital S:P ratios were not associated with better risk-adjusted outcomes and thus may not be a valid quality measure.
Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.