Is wedge a dirty word? Demographic and facility-level variables associated with high-quality wedge resectionCentral MessagePerspective
Objectives: Although sublobar resections have gained traction, wedge resections vary widely in quality. We seek to characterize the demographic and facility-level variables associated with high-quality wedge resections. Methods: The National Cancer Database was queried from 2010 to 2018. Patients wi...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-09-01
|
| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273623001912 |
| _version_ | 1797674130872467456 |
|---|---|
| author | Micaela L. Collins, MD, MPH Gregory L. Whitehorn, BS Shale J. Mack, BS Brian M. Till, MD Hamza Rshaidat, MD Tyler R. Grenda, MD, FACS Nathaniel R. Evans, III, MD, FACS Olugbenga T. Okusanya, MD, FACS |
| author_facet | Micaela L. Collins, MD, MPH Gregory L. Whitehorn, BS Shale J. Mack, BS Brian M. Till, MD Hamza Rshaidat, MD Tyler R. Grenda, MD, FACS Nathaniel R. Evans, III, MD, FACS Olugbenga T. Okusanya, MD, FACS |
| author_sort | Micaela L. Collins, MD, MPH |
| collection | DOAJ |
| description | Objectives: Although sublobar resections have gained traction, wedge resections vary widely in quality. We seek to characterize the demographic and facility-level variables associated with high-quality wedge resections. Methods: The National Cancer Database was queried from 2010 to 2018. Patients with T1/T2 N0 M0 non–small cell lung cancer 2 cm or less who underwent wedge resection without neoadjuvant therapy were included. A wedge resection with no nodes sampled or with positive margins was categorized as a low-quality wedge. A wedge resection with 4 or more nodes sampled and negative margins was categorized as a high-quality wedge. Facility-specific variables were investigated via quartile analysis based on the overall volume and proportion of high-quality wedge or low-quality wedge resections performed. Results: A total of 21,742 patients met inclusion criteria, 6390 (29.4%) of whom received a high-quality wedge resection. Factors associated with high-quality wedge resection included treatment at an academic center (3005 [47.0%] vs low-quality wedge 6279 [40.9%]; P < .001). The 30- and 90-day survivals were similar, but patients who received a high-quality wedge resection had improved 5-year survival (4902 [76.7%] vs 10,548 [68.7%]; P < .001). Facilities in the top quartile by volume of high-quality wedge resections performed 69% (4409) of all high-quality wedge resections, and facilities in the top quartile for low-quality wedge resections performed 67.6% (10,378) of all low-quality wedge resections. A total of 113 facilities were in the top quartile by volume for both high-quality wedge and low-quality wedge resections. Conclusions: High-quality wedge resections are associated with improved 5-year survival when compared with low-quality wedge resections. By volume, high-quality wedge and low-quality wedge resections cluster to a minority of facilities, many of which overlap. There is discordance between best practice guidelines and current practice patterns that warrants additional study. |
| first_indexed | 2024-03-11T21:54:41Z |
| format | Article |
| id | doaj.art-5dbca949104e4109ba4691414ed6d204 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-03-11T21:54:41Z |
| publishDate | 2023-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-5dbca949104e4109ba4691414ed6d2042023-09-26T04:12:36ZengElsevierJTCVS Open2666-27362023-09-0115481488Is wedge a dirty word? Demographic and facility-level variables associated with high-quality wedge resectionCentral MessagePerspectiveMicaela L. Collins, MD, MPH0Gregory L. Whitehorn, BS1Shale J. Mack, BS2Brian M. Till, MD3Hamza Rshaidat, MD4Tyler R. Grenda, MD, FACS5Nathaniel R. Evans, III, MD, FACS6Olugbenga T. Okusanya, MD, FACS7Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa; Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PaSidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa; Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PaSidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa; Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PaSidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa; Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PaSidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa; Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PaSidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa; Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PaSidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa; Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PaSidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa; Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa; Address for reprints: Olugbenga T. Okusanya, MD, FACS, Division of Esophageal and Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, 211 South 9th St, Suite 300, Philadelphia, PA 19107.Objectives: Although sublobar resections have gained traction, wedge resections vary widely in quality. We seek to characterize the demographic and facility-level variables associated with high-quality wedge resections. Methods: The National Cancer Database was queried from 2010 to 2018. Patients with T1/T2 N0 M0 non–small cell lung cancer 2 cm or less who underwent wedge resection without neoadjuvant therapy were included. A wedge resection with no nodes sampled or with positive margins was categorized as a low-quality wedge. A wedge resection with 4 or more nodes sampled and negative margins was categorized as a high-quality wedge. Facility-specific variables were investigated via quartile analysis based on the overall volume and proportion of high-quality wedge or low-quality wedge resections performed. Results: A total of 21,742 patients met inclusion criteria, 6390 (29.4%) of whom received a high-quality wedge resection. Factors associated with high-quality wedge resection included treatment at an academic center (3005 [47.0%] vs low-quality wedge 6279 [40.9%]; P < .001). The 30- and 90-day survivals were similar, but patients who received a high-quality wedge resection had improved 5-year survival (4902 [76.7%] vs 10,548 [68.7%]; P < .001). Facilities in the top quartile by volume of high-quality wedge resections performed 69% (4409) of all high-quality wedge resections, and facilities in the top quartile for low-quality wedge resections performed 67.6% (10,378) of all low-quality wedge resections. A total of 113 facilities were in the top quartile by volume for both high-quality wedge and low-quality wedge resections. Conclusions: High-quality wedge resections are associated with improved 5-year survival when compared with low-quality wedge resections. By volume, high-quality wedge and low-quality wedge resections cluster to a minority of facilities, many of which overlap. There is discordance between best practice guidelines and current practice patterns that warrants additional study.http://www.sciencedirect.com/science/article/pii/S2666273623001912nonanatomic resectionsurgical qualitythoracic surgerywedge resection |
| spellingShingle | Micaela L. Collins, MD, MPH Gregory L. Whitehorn, BS Shale J. Mack, BS Brian M. Till, MD Hamza Rshaidat, MD Tyler R. Grenda, MD, FACS Nathaniel R. Evans, III, MD, FACS Olugbenga T. Okusanya, MD, FACS Is wedge a dirty word? Demographic and facility-level variables associated with high-quality wedge resectionCentral MessagePerspective JTCVS Open nonanatomic resection surgical quality thoracic surgery wedge resection |
| title | Is wedge a dirty word? Demographic and facility-level variables associated with high-quality wedge resectionCentral MessagePerspective |
| title_full | Is wedge a dirty word? Demographic and facility-level variables associated with high-quality wedge resectionCentral MessagePerspective |
| title_fullStr | Is wedge a dirty word? Demographic and facility-level variables associated with high-quality wedge resectionCentral MessagePerspective |
| title_full_unstemmed | Is wedge a dirty word? Demographic and facility-level variables associated with high-quality wedge resectionCentral MessagePerspective |
| title_short | Is wedge a dirty word? Demographic and facility-level variables associated with high-quality wedge resectionCentral MessagePerspective |
| title_sort | is wedge a dirty word demographic and facility level variables associated with high quality wedge resectioncentral messageperspective |
| topic | nonanatomic resection surgical quality thoracic surgery wedge resection |
| url | http://www.sciencedirect.com/science/article/pii/S2666273623001912 |
| work_keys_str_mv | AT micaelalcollinsmdmph iswedgeadirtyworddemographicandfacilitylevelvariablesassociatedwithhighqualitywedgeresectioncentralmessageperspective AT gregorylwhitehornbs iswedgeadirtyworddemographicandfacilitylevelvariablesassociatedwithhighqualitywedgeresectioncentralmessageperspective AT shalejmackbs iswedgeadirtyworddemographicandfacilitylevelvariablesassociatedwithhighqualitywedgeresectioncentralmessageperspective AT brianmtillmd iswedgeadirtyworddemographicandfacilitylevelvariablesassociatedwithhighqualitywedgeresectioncentralmessageperspective AT hamzarshaidatmd iswedgeadirtyworddemographicandfacilitylevelvariablesassociatedwithhighqualitywedgeresectioncentralmessageperspective AT tylerrgrendamdfacs iswedgeadirtyworddemographicandfacilitylevelvariablesassociatedwithhighqualitywedgeresectioncentralmessageperspective AT nathanielrevansiiimdfacs iswedgeadirtyworddemographicandfacilitylevelvariablesassociatedwithhighqualitywedgeresectioncentralmessageperspective AT olugbengatokusanyamdfacs iswedgeadirtyworddemographicandfacilitylevelvariablesassociatedwithhighqualitywedgeresectioncentralmessageperspective |