Inpatient lung cancer surgery outcomes in Illinois

Objective

This study analyzed inpatient mortality and length of stay for lung cancer surgery in Illinois hospitals by patient clinical and demographic characteristics, procedure types, and hospital and surgeon volume.

Methods

The study analyzed lung cancer patients who underwent lobectomy or sublobar resection at Illinois hospitals from 2016 to June 2022. Trends in procedure type, inpatient mortality, one-day length of stay (LOS), and prolonged LOS (>10 days) were evaluated. Regression models were used to determine the likelihood of inpatient death and length of stay while controlling for clinical, procedure, hospital, and surgeon characteristics.

Results

There were 9602 admissions for lung cancer surgery at 89 non-federal Illinois hospitals. Overall, 0.7% of patients died, 12.2% of patients had one-day LOS, and 7.4% patients had prolonged LOS. From 2016 to 2022, rates of one-day LOS increased from approximately 5% to 23%, prolonged LOS dropped from almost 18% to under 5%, robotic lobectomies increased from <5% of procedures to over 40%, and VATS lobectomies went from almost 50% to 13%. The proportion of open lobectomy procedures remained stable. Robotic and VATS procedures were generally associated with better outcomes; however, VATS sublobar procedures were associated with worse LOS and mortality outcomes. Hospitals and surgeons with higher procedure volumes had significantly better outcomes.

Conclusions

Lung cancer surgery had low inpatient mortality and better LOS outcomes, with robotic steadily replacing VATS procedures. Higher hospital or surgeon volume was associated with better patient outcomes and may have been related to the greater utilization of Enhanced Recovery After Surgery Programs.