Lung Cancer Treatment
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.
- Mortality rate following surgery. This is the number of patients who die following surgery.
- 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.
- 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 are performed using a minimally invasive approach, at a rate significantly greater than the *UHC average for academic medical centers.
Average Length of Stay
The graph below compares the length of stay for VATS and open procedures for patients at Cedars-Sinai to the *UHC average. Because only the most complex cases are performed as an open procedure at Cedars-Sinai, this group of patients tends to have a longer length of stay than the UHC average.
The chart below compares the peri-operative mortality at Cedars-Sinai to the *UHC average. The number of open lobectomy cases is too small for purposes of reliably predicting mortality. Because of the small numbers of open lobectomy cases, mortality rates may vary considerably over time.
The chart below compares the complication rate at Cedars-Sinai to the *UHC average. Because only the most complex cases are performed as an open procedure at Cedars-Sinai, this group of patients tends to have a higher rate of complications than the UHC average.
Comparisons of Cedars-Sinai Medical Center Volume with Other Hospitals
Cedars-Sinai Medical Center performed the most lobectomies, according to 2010 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 between January 2011 and December 2011; data accessed on August 3, 2012. UHC is an alliance of 116 academic medical centers and 275 of their affiliated hospitals representing approximately 90% of the nation's non-profit academic medical centers. The comparison group is all available, full member hospitals in the UHC Clinical DataBase/Resource ManagerTM database. 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. Both populations exclude length of stay outliers.
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