The Association of Short-Term Quality Metrics and Long-Term Survival After Lung Cancer Resection
Presented During:
Sunday, May 4, 2025: 9:00AM - 4:00PM
Seattle Convention Center | Summit
Posted Room Name:
Poster Area, Exhibit Hall
Abstract No:
P0193
Submission Type:
Abstract Submission
Authors:
Mark Berry (1), David Richard P. Woodson (2), Ntemena Kapula (3), Douglas Liou (3), Irmina Elliott (4), Joseph Shrager (5)
Institutions:
(1) Leland Stanford Junior University, Stanford, CA, (2) Stanford Unversity, Stanford, CA, (3) Stanford University Medical Center, Stanford, CA, (4) N/A, Stanford, CA, (5) Stanford University, Stanford, CA
Submitting Author:
*Mark Berry
-
Contact Me
Leland Stanford Junior University
Leland Stanford Junior University
Co-Author(s):
David Richard Woodson
-
Contact Me
Stanford Unversity
Stanford Unversity
Ntemena Kapula
-
Contact Me
Stanford University Medical Center
Stanford University Medical Center
Douglas Liou
-
Contact Me
Stanford University Medical Center
Stanford University Medical Center
Irmina Elliott
-
Contact Me
N/A
N/A
*Joseph Shrager
-
Contact Me
Stanford University
Stanford University
Presenting Author:
David Richard Woodson
-
Contact Me
Stanford Unversity
Stanford Unversity
Abstract:
Objective: Quality metrics based on short-term peri-operative outcomes are increasingly used to compare care across institutions. This study evaluated whether short-term quality metrics for non-small cell lung cancer (NSCLC) resections predict long-term survival outcomes.
Methods: Centers in the National Cancer Database that performed ≥ 30 pulmonary resections for NSCLC between 2010 and 2019 were ranked based on previously established measures of major postoperative morbidity, defined as a composite of 30-day mortality, unplanned readmissions and hospital stays longer than 14 days. Mortality was weighted at 4 times the value of morbidity (unplanned readmissions and prolonged hospital stays) in the composite. Centers were stratified into quintiles, with the top quintile (least morbid) designated as high-quality. The impact of institutional quality on long-term survival was assessed with Kaplan-Meier analysis and Cox proportional hazards modeling.
Results: The study included 198,115 patients from 928 centers. High-quality centers had a 30-day postoperative mortality rate of 0.8% (362/47,321) and a median morbidity rate of 5% (Interquartile Range [IQR] 4.0%, 5.9%) compared to a 2.4% postoperative mortality rate (3,614/150,794) and a median morbidity rate of 10.8% (IQR 8.7%, 14.0%) at non-high-quality centers (p<0.001 for both mortality and morbidity). Patients treated at high-quality centers had improved long-term survival compared to patients treated at non-high-quality institutions in both univariable (5-year survival 71.5% [95% Confidence Interval {CI} 71.0-71.9%] vs 62.6% [95% CI 62.3-62.8%], p<0.0001) and multivariable analysis (hazard ratio [HR] 0.72 [95% CI 0.71-0.74], p<0.001) that included stage and other factors (Figure). Sensitivity analysis of stage IA patients treated with lobectomy and no induction therapy showed similar benefits to having surgery at a high-quality institution in both univariable (5-year survival 79% [95% CI 78.3-79.7%] vs 73.2% [95% CI 72.8-73.6%], p<0.001) and multivariable (HR 0.76 [95% CI 0.73-0.78], p<0.001) analyses.
Conclusion: Patients who underwent lung cancer resection at institutions deemed high-quality based on short-term perioperative outcomes also had better long-term survival, suggesting that short-term perioperative outcome-based quality metrics are sufficient in predicting long-term outcomes in lung cancer resections of NSCLC.
Methods: Centers in the National Cancer Database that performed ≥ 30 pulmonary resections for NSCLC between 2010 and 2019 were ranked based on previously established measures of major postoperative morbidity, defined as a composite of 30-day mortality, unplanned readmissions and hospital stays longer than 14 days. Mortality was weighted at 4 times the value of morbidity (unplanned readmissions and prolonged hospital stays) in the composite. Centers were stratified into quintiles, with the top quintile (least morbid) designated as high-quality. The impact of institutional quality on long-term survival was assessed with Kaplan-Meier analysis and Cox proportional hazards modeling.
Results: The study included 198,115 patients from 928 centers. High-quality centers had a 30-day postoperative mortality rate of 0.8% (362/47,321) and a median morbidity rate of 5% (Interquartile Range [IQR] 4.0%, 5.9%) compared to a 2.4% postoperative mortality rate (3,614/150,794) and a median morbidity rate of 10.8% (IQR 8.7%, 14.0%) at non-high-quality centers (p<0.001 for both mortality and morbidity). Patients treated at high-quality centers had improved long-term survival compared to patients treated at non-high-quality institutions in both univariable (5-year survival 71.5% [95% Confidence Interval {CI} 71.0-71.9%] vs 62.6% [95% CI 62.3-62.8%], p<0.0001) and multivariable analysis (hazard ratio [HR] 0.72 [95% CI 0.71-0.74], p<0.001) that included stage and other factors (Figure). Sensitivity analysis of stage IA patients treated with lobectomy and no induction therapy showed similar benefits to having surgery at a high-quality institution in both univariable (5-year survival 79% [95% CI 78.3-79.7%] vs 73.2% [95% CI 72.8-73.6%], p<0.001) and multivariable (HR 0.76 [95% CI 0.73-0.78], p<0.001) analyses.
Conclusion: Patients who underwent lung cancer resection at institutions deemed high-quality based on short-term perioperative outcomes also had better long-term survival, suggesting that short-term perioperative outcome-based quality metrics are sufficient in predicting long-term outcomes in lung cancer resections of NSCLC.
THORACIC:
Lung Cancer
Image or Table
