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Ann Thorac Surg. 2014 Jul;98(1):175-81; discussion 182. doi: 10.1016/j.athoracsur.2014.03.014. Epub 2014 May 1.

Lung resection outcomes and costs in Washington State: a case for regional quality improvement.

Author information

1
Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington; Surgical Outcomes Research Center, University of Washington, Seattle, Washington. Electronic address: ffarjah@uw.edu.
2
Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
3
Providence Physician Group Cardiac and Thoracic Surgery, Everett, Washington.
4
Franciscan Health System, Catholic Health Initiatives, Tacoma, Washington.
5
Thoracic Surgery Division, Swedish Cancer Institute, Seattle, Washington.
6
Virginia Mason Medical Center, Seattle, Washington.
7
Surgical Outcomes Research Center, University of Washington, Seattle, Washington.

Abstract

BACKGROUND:

A regional quality improvement effort does not exist for thoracic surgery in the United States. To initiate the development of one, we sought to describe temporal trends and hospital-level variability in associated outcomes and costs of pulmonary resection in Washington (WA) State.

METHODS:

A cohort study (2000-2011) was conducted of operated-on lung cancer patients. The WA State discharge database was used to describe outcomes and costs for operations performed at all nonfederal hospitals within the state.

RESULTS:

Over 12 years, 8,457 lung cancer patients underwent pulmonary resection across 49 hospitals. Inpatient deaths decreased over time (adjusted p-trend=0.023) but prolonged length of stay did not (adjusted p-trend=0.880). Inflation-adjusted hospital costs increased over time (adjusted p-trend<0.001). Among 24 hospitals performing at least 1 resection per year, 5 hospitals were statistical outliers in rates of death (4 lower and 1 higher than the state average), and 13 were outliers with respect to prolonged length of stay (7 higher and 6 lower than the state average) and costs (5 higher and 8 lower than the state average). When evaluated for rates of death and costs, there were hospitals with fewer deaths/lower costs, fewer deaths/higher costs, more deaths/lower costs, and more deaths/higher costs.

CONCLUSIONS:

Variability in outcomes and costs over time and across hospitals suggest opportunities to improve the quality and value of thoracic surgery in WA State. Examples from cardiac surgery suggest that a regional quality improvement collaborative is an effective way to meaningfully and rapidly act upon these opportunities.

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