Surgeon-determined variability in quality of surgical resection of lung cancer.

Abstract

7068 Background: Surgical resection is the main curative modality for patients with non-small cell lung cancer (NSCLC). Curative intent requires attainment of certain quality measures, including R0 resection, examination of hilar/pulmonary and mediastinal lymph nodes. Pneumonectomy and wedge resections may be associated with increased morbidity or suboptimal oncologic outcomes. We have previously demonstrated disparity in attainment of good quality resection (GQR) criteria in a large community cohort. We hypothesized that individual surgeons' practice may be the major determinant of attainment of GQR and sought to examine the extent of variability in surgical practice. Methods: All curative-intent resections for NSCLC in the Memphis Metropolitan Area from 1/1/04 to 12/31/08 were reviewed for quality measures and attainment of GQR by NCCN and RADIANT trial criteria. Surgeons were grouped by rate of failure to attain GQR criteria and the number of patients at risk was stratified by surgeon group. Results: 746 surgeries performed by 21 board-certified cardiothoracic or general thoracic surgeons were included. Performance is demonstrated (Table). Seven surgeons failed to meet NCCN criteria and 5 surgeons failed to meet RADIANT criteria in 100% of cases, affecting 168 and 134 patients. Conclusions: There is a wide amplitude of variability in performance of GQR by board-certified surgeons in this community-based cohort. In an era emphasizing quality of care and potential pay for performance there needs to be improvement in the characteristics of surgical resection in NSCLC. Rate (%) Surgeons N = 21 Patients N = 746 Resection with positive margins <5 10 233 5-10 8 458 >10 3 55 Resection without mediastinal lymph nodes <10 2 11 10-50 12 535 >50 7 200 Resection without any lymph nodes <10 8 266 10-20 10 455 >20 3 25 Pneumonectomy rate <5 7 194 5-15 7 389 >15 7 163 Wedge resection rate <5 5 102 5-15 11 493 >15 5 151 Failure to meet NCCN criteria <80 2 72 80-99 12 506 100 7 168 Failure to meet RADIANT criteria <80 11 432 80-99 5 180 100 5 134 No significant financial relationships to disclose.