Comprehensive value implications of surgeon volume for lung cancer surgery: Use of an analytic framework within a regional health system

Objective: We used a framework to assess the value implications of thoracic surgeon operative volume within an 8-hospital health system.Methods: Surgical cases for non-small cell lung cancer were assessed from March 2015 to March 2021.High-volume (HV) surgeons performed >25 pulmonary resections annually.Metrics include length of stay, infection rates, 30-day readmission, in-hospital mortality, median 30-day charges and direct costs, and 3-year recurrence-free and overall survival.Multivariate regression-based propensity scores matched patients between groups.Metrics were graphed on radar charts to conceptualize total value.Results: All 638 lung resections were performed by 12 surgeons across 6 hospitals.Two HV surgeons performed 51% (n 324) of operations, and 10 low-volume surgeons performed 49% (n 314).Median follow-up was 28.8 months (14.0-42.3months).Lobectomy was performed in 71% (n 450) of cases.HV surgeons performed more segmentectomies (33% [n 107] vs 3% [n 8]; P<.001).Patients of HV surgeons had a lower length of stay (3 [2-4] vs 5 [3-7]; P < .001)and infection rates (0.6% [n 1] vs 4% [n 7]; P .03).Low-volume and HV surgeons had similar 30-day readmission rates (14% [n 23] vs 7% [n 12]; P .12),in-hospital mortality (0% [n 0] vs 0.6% [n 1]; P .33),and oncologic outcomes; 3-year recurrence-free survival was 95% versus 91%; P .44,and 3-year overall survival was 94% versus 90%; P 0. Charges were reduced by 28%, and direct costs were reduced by 23% (both P < .001) in the HV cohort.Conclusions: HV surgeons provide comprehensive value across a health system.This multidomain framework can be used to help drive oncologic care decisions within a health system.