Surgical Outcomes in the National Lung Screening Trial Compared With Contemporary Practice.

Authors

Savitch SL, Zheng R, Abdelsattar ZM, Barta JA, Okusanya OT, Evans NR, Grenda TR

Affiliations

• Division of Thoracic Surgery, Sidney Kimmel Medical College, Philadelphia, Pennsylvania. Electronic address: sasavitc@med.umich.edu.
• Division of Thoracic Surgery, Sidney Kimmel Medical College, Philadelphia, Pennsylvania.
• Department of Cardiovascular and Thoracic Surgery, Loyola University, Chicago, Illinois.
• Division of Pulmonary, Allergy, and Critical Care Medicine, Sidney Kimmel Medical College, Philadelphia, Pennsylvania.

Abstract

BACKGROUND: The National Lung Screening Trial (NLST) established a role for lung cancer screening. Mortality benefits with screening are predicated on successful treatment with low surgical mortality. Given variations observed in perioperative outcomes following lung cancer resection, it remains unknown if benefits observed in the NLST are generalizable to a broader population. We sought to determine if NLST perioperative outcomes are reflective of contemporary practice in a national cohort.

METHODS: We identified patients diagnosed with non-small cell lung cancer who underwent lung resection in the 2014-2015 National Cancer Database (NCDB) and the NLST. We compared demographic and cancer characteristics in both datasets. We used hierarchical logistic regression to compare 30-day and 90-day postoperative mortality across facilities in both datasets.

RESULTS: 65,054 patients in NCDB and 1,003 patients in the NLST treated across 1,119 NCDB hospitals and 33 NLST hospitals were included. After risk- and reliability-adjustment, mean 30-day and 90-day mortality were significantly higher among NCDB hospitals (mean [95% CI]; 30-day: 2.2 [2.2-2.2] vs. 1.8 [1.8-1.8], p<0.001; 90-day: 4.2 [4.2-4.3] vs. 2.9 [2.9-2.9], p<0.001). Variation in risk- and reliability-adjusted 30-day (1.1%-4.9%) and 90-day (2.6%-9.7%) mortality was observed among NCDB hospitals. Adjusted mortality was similar among NLST facilities (30-day: 1.8%-1.8%; 90-day: 2.9%-2.9%).

CONCLUSIONS: Risk- and reliability-adjusted postoperative mortality varies widely in a national cohort compared to outcomes observed in the NLST. Efforts to minimize this variation are needed to ensure that benefits of lung cancer screening are fully realized in the United States.