P193. The Association of Short-Term Quality Metrics and Long-Term Survival After Lung Cancer Resection
Stanford Hospital
Atlanta, GA
United States - Contact Me
David Richard Woodson is a second-year medical student at Morehouse School of Medicine, expected to graduate in May 2027. He has a strong interest in cardiothoracic surgery and a deep passion for research, mentorship, and community service. Before medical school, he earned a Master of Science in Physiology and Biophysics from Georgetown University in 2023 and completed Bachelor degrees in Biology and Economics at Stony Brook University in 2022.
His research experience spans various institutions, including Stony Brook University, Stanford University and Morehouse School of Medicine, where he has contributed to studies on cardiovascular science, quality metrics in lung cancer resections, and interventions to improve STEM interest among underrepresented students. David has also conducted field research in Madagascar, exploring biodiversity conservation and local perceptions of medicine.
Description
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.
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