Effect of surgical volume and hospital type on outcome in non-small cell lung cancer surgery: A Finnish population-based study

Abstract

Hospital mortality and long-term survival in major cancer surgery seems to be affected by hospital related factors. We evaluated the effect of university versus non-university hospital type, and surgical volume (0-4, 5-10, 11-20, and >20 average of cases/year) on the immediate and long-term survival of surgical non-small cell lung cancer (NSCLC) patients. Between 1988 and 2002, the number of NSCLC resections with curative intent in Finland was 5339. Follow-up until the end of 2003 from national registries was available on 91% (4878 of 5339) of patients. Multivariate analysis showed that hospital mortality was unaffected by hospital type or volume, but delay of >4 months from diagnosis to surgery did have an adverse effect. Surgery at university hospitals was associated with significantly better cancer-related and overall survival, as also was surgery at very low-volume but mainly private hospitals (0-4 cases/year). Undergoing surgery for non-small cell lung cancer at a university hospital may offer an advantage for long-term survival, but large hospital volume in itself did not. Multivariate analysis on the effect of hospital type and surgical volume on immediate and long-term survival of 4878 lung cancer surgery patients, 1988-2002, showed that surgery at university hospitals was associated with significantly better cancer-related and overall survival, but hospital mortality did not differ. Large hospital volume did not independently predict a better outcome.