Impact of Hospital Volume on Chest Tube Duration, Length of Stay, and Mortality After Lobectomy

Abstract

Numerous studies have suggested an inverse relationship between hospital volume and short-term mortality after various major operations. However, the volume-outcome relationship after lung cancer surgery remains controversial. We investigated the effects of hospital volume on various outcomes after lobectomy for lung cancer, including chest tube duration, postoperative length of stay, and in-hospital mortality. From a total of 5.85 million inpatients in the Japanese Diagnosis Procedure Combination database, we identified 19,831 patients who underwent lobectomy for lung cancer between July and December in 2007 and 2008. Patients were divided into low (≤24 per year), medium-low (25 to 43), medium-high (44 to 67), or high (≥68) hospital-volume groups. Multivariate regression analyses were conducted to analyze the concurrent effects of various factors on postoperative outcomes. Overall in-hospital mortality was 0.69%, and was significantly lower in the high-volume group compared with the low-volume group (0.48% versus 0.94%; odds ratio 0.60; p=0.047). Chest tube removal occurred earlier in the high-volume group than in the low-volume group (mean 4.0 days versus 5.1; p<0.001). Postoperative length of stay was shorter in the high-volume group than in the low-volume group (mean 11.5 days versus 15.9, p<0.001). Higher hospital volume was associated with significantly shorter chest tube duration and postoperative length of stay, and lower in-hospital mortality after lobectomy for lung cancer. However, the differences in outcomes between high-volume and low-volume hospitals may be too small to support regionalization of lung cancer operations to high-volume centers.