The effect of surgeon volume on procedure selection in non–small cell lung cancer surgeries
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OBJECTIVES: Procedure selection by the surgeon can greatly affect patients' operative and long-term survival. This selection potentially reflects comfort with technically challenging surgeries. This study aims to examine surgeon choices for non-small cell lung cancer and whether surgeon volume predicts the type of procedure chosen, controlling for patient demographics, comorbidity, year of surgery, and institutional factors. METHODS: Data were abstracted from an Ontario population-based linked database from 2004 to 2011. Patient demographics, comorbidities, year of surgery, and institutional and surgical factors were evaluated. Three-level, random-effect, multilevel regression analyses were performed to examine factors influencing operative selection. RESULTS: Over the interval, 8070 patients (50.4% were male) underwent surgical resection, including pneumonectomy (n = 842), lobectomy (n = 6212), and wedge resection (n = 1002). Resections were performed by 124 unique physicians in 45 institutions. The proportion of patients undergoing pneumonectomy decreased from 14.8% in 2004 to 7.6% in 2011. Multilevel regression analysis showed physician volume, age, year of procedure, gender, and comorbidities were predictive of performing a pneumonectomy. By adjusting for these variables, the results indicated that for each 10-unit increase in physician volume, the relative risk of performing a pneumonectomy decreased by 9.1% (95% confidence interval, 8.2-10.0, P = .04). CONCLUSIONS: Although patient and temporal factors influence the type of resection a patient receives for non-small cell lung cancer, surgeon volume also is a strong predictor. This study may be limited by minimal stage data, but the suggestion that a surgeon's total procedural volume for non-small cell lung cancer significantly influences procedure selection has implications on how we deliver care to this patient population.
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