Thoracic surgeons at the Women's Guild Lung Institute continually monitor the quality of care provided to patients with lung cancer who come to the center for treatment. Among the aspects of care that are measured are:
- Route: At Cedars-Sinai, the surgeons compare volumes and outcomes for patients receiving minimally invasive video-assisted thoracoscopic surgery (VATS) and more traditional open surgery. VATS surgery has shown results comparable to open surgery but with less pain, fewer deaths following surgery, and shorter hospital stays.
- Average length of stay in the hospital. Patients tend to get better faster when they recover in a familiar setting. Spending less time in a hospital also means less exposure to infections and other diseases.
- Complication rates. Major surgery can sometimes lead to complications. For a person undergoing surgery for lung cancer, complications can include pneumothorax (air leaking from the lungs for seven days or more), irregular heart beats (atrial fibrillation) that requires treatment and respiratory or heart failure.
- Mortality rate following surgery. This is the number of patients who die in the hospital following surgery.
- Volume: Studies suggest that for many surgical procedures, hospitals that perform high volumes have better quality outcomes, i.e. lower short-term and long term mortality and morbidity. Volume is an indicator of experience, which influences outcomes in multiple ways. In addition to the experience of surgeons in performing specific procedures, high volume hospitals may institute specific care processes that improve outcomes and have the infrastructure dedicated to particular clinical specialties, including related technology and intensive care personnel. Commitment to quality standards throughout the institution is also an important determinant of better outcomes.1,2 In addition, outcomes for high-risk procedures have been shown to be better when performed by more highly-trained surgeons than by general surgeons.3
Most of the lobectomy procedures for lung cancer patients at Cedars-Sinai Medical Center (CSMC) are performed using a minimally invasive approach, at a rate significantly greater than the compare group* of California hospitals.
Average Length of Stay
The graph below shows the length of stay for lung cancer patients undergoing an open or VATS procedure at Cedars-Sinai vs. a compare group* of similar hospitals in California.
The graph below shows the percentage of lung cancer patients with one or more complications at Cedars-Sinai vs. a compare group* of similar hospitals in California.
The chart below compares the peri-operative mortality at Cedars-Sinai to the expected mortality for patients with similar risk factors. The peri-operative mortality for lung cancer patients at Cedars-Sinai is lower than expected, based on data from UHC*.
Comparisons of Cedars-Sinai Medical Center Volume with Other Hospitals
Cedars-Sinai Medical Center performed the most lobectomies, according to 2012 data collected by the California Office of Statewide Health Planning and Development (OSHPD) on the volumes of lung cancer patients treated at California hospitals.
*Source: UHC Clinical DataBase/Resource ManagerTM, patients discharged during 2013; data accessed on March 21, 2014. UHC is an alliance of 120 academic medical centers and 301 of their affiliated hospitals representing the nation's leading academic medical centers. The comparison group is a subset of five California facilities that perform a high volume of lung cancer surgeries. Open cases are those with a primary ICD-9 procedure code 32.39, 32.49, or 32.59. VATS cases are defined by the primary ICD-9 procedure codes 32.30, 32.41, 32.50. Lung cancer patients are those with any ICD-9 diagnosis 162,1620,1623-1625,1628,1629,1764,1970, 20921, or 2312.
1Bach PB, Ann Intern Med 2009; 150:729-30
2Greene FL, Ann Surg Oncol 2007; 15:14-15
3Kozower BD et al, Ann Thorac Surg 2008; 86:1405-08