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 are performed using a minimally invasive approach.
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. the expected* length of stay for a clinically similar group of patients.
The graph below shows the percentage of lung cancer patients with one or more complications. Expected complication rate data is not available.
The chart below compares the peri-operative mortality at Cedars-Sinai to the expected mortality for patients with similar risk factors. The perioperative mortality for lung cancer patients at Cedars-Sinai in 2015 was 0, which is lower than expected*, based on data from UHC.
Comparisons of Cedars-Sinai Volume With That of Other Hospitals
Cedars-Sinai Medical Center performed the most lobectomies, according to 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 2015. UHC is an alliance of more than 300 of the nation’s non-profit academic medical centers and their affiliated hospitals. The majority of these facilities participate in UHC's Clinical DataBase/Resource Manager. *Effective for all discharges as of Oct. 1, 2015, the U.S. Department of Health and Human Services mandated that any entity covered by the Health Insurance Portability and Accountability Act switch from ICD-9 to ICD-10 for medical coding. The new code set provides a significant increase in the specificity of the reporting, allowing more information to be conveyed in a code. In order to ensure accurate comparisons of observed to expected for Length of Stay and Mortality measures, data is reported separately for those cases coded with ICD-9 (January – September 2015) vs. those coded using ICD-10 (October-December 2015). The January-September data was accessed on Feb. 15, 2016, and the October-December data was accessed on March 11, 2016.
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