Original article
General thoracic
Reintervention and Survival After Limited Lung Resection for Lung Cancer Treatment in Australia

https://doi.org/10.1016/j.athoracsur.2018.11.045Get rights and content

Background

To investigate the risk and predictors of reintervention (surgery or radiotherapy) after limited resection for lung cancer.

Methods

A population-based, all-inclusive study using linked data from the New South Wales Admitted Patient Data Collection and Death Register included all patients undergoing limited resection for lung cancer between July 1, 2002, and March 31, 2014. Univariate and adjusted competing risk analyses were used to estimate the effect of potential factors for risk of reintervention within 6 months and 24 months of the initial surgery.

Results

The overall 5-year survival for lung cancer patients undergoing limited lung resection was 52% (49% to 54%); for patients aged 70 years or more, the survival rate was 44% (40% to 47%). Reintervention occurred in 6.2% by 6 months and 11.3% by 24 months after the surgery. Younger age, surgery in private hospitals, and fewer comorbidities were independently associated with increased risk of reintervention. Patients who had the surgery performed in high surgical volume hospitals had 49% lower risk of reintervention within the first 6 months (95% confidence interval: 0.30 to 0.85). The effect of hospital surgical volume was attenuated by 24 months (hazard ratio 0.87, 95% confidence interval: 0.60 to 1.28). Patients undergoing reintervention within 6 months or 24 months had a twofold (1.52 to 2.57) and 2.3-fold (1.89 to 2.83) increased risk of death, respectively.

Conclusions

The reintervention rate within 6 or 24 months of initial limited lung cancer resection was modest, but there was considerable variation among hospitals. Reintervention was not a benign event and was associated with lower survival in an Australian population.

Section snippets

Data Sources

We used data from the New South Wales (NSW) Admitted Patients Data Collection, including records of all separations (discharges, transfers, and deaths) from public and private hospitals and day procedure centers in the state of New South Wales, Australia. The Admitted Patients Data Collection reports patient demographics, together with principal and secondary diagnoses according to the International Statistical Classification of Diseases and Related Problems, 10th Revision, Australian

Results

For the entire study period between July 1,2001, and March 31, 2014, of 44,063 patients admitted to hospital with a diagnosis of lung cancer, 2,067 patients (4.7%) underwent limited lung resection. The average age of these patients was 67.9 years (median 69, SD 10.3) and 56% were men. The overall 5-year survival for these patients was 52% (49% to 54%), and 44% (40% to 47%) for patients aged 70 years or more. There were 1,739 patients eligible for analyses of reintervention within 6 months and

Comment

Using hospital data for NSW between July 1, 2001, and March 31, 2014, we found that 4.7% of lung cancer patients underwent limited lung resection. The overall 5-year survival for these patients was 52%. Among them, 6.2% and 11.3% had reintervention within 6 and 24 months, respectively, after the initial limited lung resection. Characteristics of patients and hospitals were independently associated with risk of reintervention. Patients whose surgery was performed in private hospitals was more

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    © 2019 by The Society of Thoracic Surgeons Published by Elsevier