Risk of death after complication for patients who have undergone lung cancer resection is higher at hospitals with high mortality rates, which may explain the wide variations in such rates across hospitals, according to a recent study published online ahead of print in JAMA Surgery.
Researchers led by Tyler Grenda, MD, of the University of Michigan, in Ann Arbor, MI, conducted a retrospective cohort study of 645 patients who received lung cancer resections from January 2006 to December 2007 in 18 low-mortality hospitals and 25 high-mortality hospitals.
They used hierarchical logistic regression upon adjusting for patient characteristics in order to determine differences in complications as well as failure-to-rescue rates, defined as death after complication.
Among those patients, overall unadjusted mortality rates were found to be 1.6% in low-mortality hospitals and 10.8% in high-mortality hospitals. Adjusting for risk, difference in mortality risk was attenuated but remained significant.
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Failure-to-rescue risk was also found to be significantly higher in high-mortality hospitals. While complication rates were found to be higher in high-mortality hospitals, the researchers found that the difference was not significant. Likelihood of surgical or cardiopulmonary complications was similar between low- and high-mortality hospitals.
“This finding emphasizes the need for better understanding of the factors related to complications and their subsequent management,” the authors concluded.
- Grenda TR, Revels SL, Yin H, et al. Lung cancer resection at hospitals with high vs low mortality rates. JAMA Surgery. 2015. [epub ahead of print]. doi:10.1001/jamasurg.2015.2199.