Table 1.
Patient Characteristics and Hospital Practices by Per-Center Adjusted Rate of Surgical Therapy Quartile
| Characteristic | Top 25th Percentile Rate (n = 65,331) | 50th-75th Percentile Rate (n = 63,109) | 25th-50th Percentile Rate (n = 56,679) | Bottom 25th Percentile Rate (n = 30,133) | p Value |
|---|---|---|---|---|---|
| Patient characteristics | |||||
| Age at diagnosis, years | 68.82 ± 9.77 | 69.06 ± 9.70 | 69.31 ± 9.71 | 69.68 ± 9.53 | <0.001 |
| Sex, male | 29,788 (45.6) | 29,385 (46.6) | 26,926 (47.5) | 14,758 (49.0) | <0.001 |
| Race | <0.001 | ||||
| White | 57,664 (88.3) | 55,731 (88.3) | 49,715 (87.7) | 26,100 (86.6) | |
| Black | 5,105 (7.8) | 5,295 (8.4) | 5,449 (9.6) | 3,348 (11.1) | |
| Other | 2,562 (3.9) | 2,083 (3.3) | 1,515 (2.7) | 685 (2.3) | |
| Charlson-Deyo Score | <0.001 | ||||
| 0 | 33,052 (50.6) | 32,321 (51.2) | 29,492 (52.0) | 17,057 (56.6) | |
| 1 | 22,427 (34.3) | 21,337 (33.8) | 18,534 (32.7) | 8,729 (29.0) | |
| ≥2 | 9,852 (15.1) | 9,451 (15.0) | 8,653 (15.3) | 4,347 (14.4) | |
| Insurance | <0.001 | ||||
| Private | 18,444 (28.2) | 16,061 (25.4) | 13,146 (23.2) | 6,231 (20.7) | |
| Medicare/Medicaid | 44,839 (68.6) | 44,354 (70.3) | 41,036 (72.4) | 22,142 (73.5) | |
| Other government | 432 (0.7) | 796 (1.3) | 819 (1.4) | 684 (2.3) | |
| Uninsured | 773 (1.2) | 1,016 (1.6) | 995 (1.8) | 624 (2.1) | |
| Income quartile | <0.001 | ||||
| Top | 25,974 (40.3) | 17,308 (27.8) | 14,130 (25.2) | 4,739 (15.9) | |
| Second | 12,815 (19.9) | 15,295 (24.6) | 14,813 (26.4) | 9,439 (31.7) | |
| Third | 16,564 (25.7) | 17,143 (27.5) | 16,248 (29.0) | 7,385 (24.8) | |
| Bottom | 9,061 (14.1) | 12,505 (20.1) | 10,825 (19.3) | 8,229 (27.6) | |
| Distance travelled, miles | 28.96 ± 110.57 | 31.61 ± 102.68 | 23.25 ± 79.30 | 21.38 ± 56.21 | <0.001 |
| Days from diagnosis to treatment | 34.87 ± 45.37 | 40.16 ± 46.43 | 42.29 ± 47.10 | 47.95 ± 51.23 | <0.001 |
| Tumor characteristics | |||||
| Diagnostic confirmation | <0.001 | ||||
| Microscopic evaluation of tissue specimen | 61,388 (94.0) | 57,488 (91.1) | 51,048 (90.1) | 26,378 (87.5) | |
| Microscopic evaluation of cytologic specimen | 3,212 (4.9) | 4,491 (7.1) | 4,651 (8.2) | 3,099 (10.3) | |
| Imaging diagnosis only | 599 (0.9) | 896 (1.4) | 779 (1.4) | 529 (1.8) | |
| Clinical stage | <0.001 | ||||
| 1 | 2,074 (3.2) | 2,896 (4.6) | 3,027 (5.3) | 2,284 (7.6) | |
| 1A | 44,752 (68.5) | 41,327 (65.5) | 35,999 (63.5) | 17,724 (58.8) | |
| 1B | 18,505 (28.3) | 18,886 (29.9) | 17,653 (31.1) | 10,125 (33.6) | |
| Pathologic stage | <0.001 | ||||
| 1A | 26,526 (40.6) | 21,712 (34.4) | 16,428 (29.0) | 6,295 (20.9) | |
| 1B | 12,834 (19.6) | 11,418 (18.1) | 9,247 (16.3) | 3,701 (12.3) | |
| 2A | 2,513 (3.8) | 2,140 (3.4) | 1,762 (3.1) | 643 (2.1) | |
| 2B | 2,042 (3.1) | 1,638 (2.6) | 1,338 (2.4) | 529 (1.8) | |
| 3A | 1,987 (3.0) | 1,689 (2.7) | 1,289 (2.3) | 431 (1.4) | |
| 3B | 491 (0.8) | 356 (0.6) | 261 (0.5) | 97 (0.3) | |
| 4 | 304 (0.5) | 318 (0.5) | 224 (0.4) | 88 (0.3) | |
| No pathologic staging | 17,667 (27.0) | 22,723 (36.0) | 25,153 (44.4) | 17,797 (59.0) | |
| Hospital characteristics | |||||
| Facility type | <0.001 | ||||
| Academic | 27,763 (42.7) | 24,808 (39.5) | 13,939 (24.7) | 7,686 (25.6) | |
| Community | 3,926 (6.0) | 4,291 (6.8) | 4,196 (7.4) | 5,270 (17.6) | |
| Comprehensive | 29,424 (45.3) | 26,498 (42.2) | 30,250 (53.6) | 15,608 (52.0) | |
| Integrated | 3,845 (5.9) | 7,144 (11.4) | 8,026 (14.2) | 1,460 (4.9) | |
| Facility volume quartile | <0.001 | ||||
| Top 25th percentile | 43,260 (66.2) | 40,761 (64.6) | 35,065 (61.9) | 12,462 (41.4) | |
| 50th-75th percentile | 12,987 (19.9) | 14,189 (22.5) | 14,601 (25.8) | 8,843 (29.3) | |
| 25th-50th percentile | 7,889 (12.1) | 6,956 (11.0) | 5,235 (9.2) | 5,231 (17.4) | |
| Bottom 25th percentile | 1,195 (1.8) | 1,203 (1.9) | 1,778 (3.1) | 3,597 (11.9) | |
| Surgical treatment characteristics and secondary outcome measures | |||||
| Reason for no operation | <0.001 | ||||
| Operation performed | 52,850 (80.9) | 44,126 (69.9) | 34,092 (60.1) | 13,284 (44.1) | |
| Operation not part of planned first course treatment | 7,657 (11.7) | 13,519 (21.4) | 17,292 (30.5) | 14,055 (46.6) | |
| Operation contraindicated | 3,757 (5.8) | 4,143 (6.6) | 3,970 (7.0) | 2,015 (6.7) | |
| Operation refused | 945 (1.4) | 1,160 (1.8) | 1,083 (1.9) | 630 (2.1) | |
| Surgical approach | <0.001 | ||||
| Open | 16,507 (25.3) | 15,929 (25.2) | 12,405 (21.9) | 5,395 (17.9) | |
| No operation | 7,702 (11.8) | 11,907 (18.9) | 13,656 (24.1) | 9,785 (32.5) | |
| Robotic assisted | 2,340 (3.6) | 2,356 (3.7) | 1,311 (2.3) | 388 (1.3) | |
| VATS | 10,385 (15.9) | 6,663 (10.6) | 5,220 (9.2) | 1,288 (4.3) | |
| Surgical procedure | <0.001 | ||||
| No operation | 12,481 (19.1) | 18,983 (30.1) | 22,587 (39.9) | 16,849 (55.9) | |
| Lobar resection | 36,911 (56.5) | 32,362 (51.3) | 25,949 (45.8) | 10,190 (33.8) | |
| Pneumonectomy | 992 (1.5) | 960 (1.5) | 765 (1.3) | 356 (1.2) | |
| Sublobar resection | 14,947 (22.9) | 10,804 (17.1) | 7,378 (13.0) | 2,738 (9.1) | |
| Length of stay, days | 6.14 ± 6.36 | 6.83 ± 6.74 | 6.94 ± 6.67 | 7.20 ± 6.53 | <0.001 |
| 30-day mortality | 859 (1.9) | 896 (2.3) | 682 (2.3) | 315 (2.7) | <0.001 |
| 90-day mortality | 1,629 (3.5) | 1,562 (4.1) | 1,222 (4.1) | 552 (4.8) | <0.001 |
| Nonsurgical treatment characteristics | |||||
| Radiation therapy provided | <0.001 | ||||
| Beam radiation | 9,581 (14.7) | 14,075 (22.3) | 16,410 (29.0) | 11,693 (38.8) | |
| Not specified or unknown | 1,630 (2.5) | 1,211 (1.9) | 791 (1.4) | 373 (1.2) | |
| Radiation not administered | 54,120 (82.8) | 47,823 (75.8) | 39,478 (69.7) | 18,067 (60.0) | |
| Regional dose, cGy, if provided | 4,058.18 ± 17,632.46 | 4,566.53 ± 18,093.49 | 4,580.76 ± 17,176.86 | 5,657.80 ± 18,590.24 | <0.001 |
| Chemotherapy provided | |||||
| Chemotherapy not administered | 46,852 (71.7) | 44,961 (71.2) | 40,216 (71.0) | 20,979 (69.6) | <0.001 |
| Chemotherapy recommended but contraindicated | 2,849 (4.4) | 2,518 (4.0) | 2,442 (4.3) | 1,151 (3.8) | |
| Chemotherapy recommended but refused | 3,969 (6.1) | 3,900 (6.2) | 3,291 (5.8) | 1,626 (5.4) | |
| Multi-agent chemotherapy | 7,584 (11.6) | 7,482 (11.9) | 7,123 (12.6) | 4,154 (13.8) | |
| Single-agent chemotherapy | 1,688 (2.6) | 2,006 (3.2) | 2,109 (3.7) | 1,383 (4.6) |
Values are expressed as mean ± SD or n (%) unless otherwise indicated.
Patient, tumor, and treatment center characteristics were stratified by the per-center adjusted rate of surgery. Treating centers were stratified into quartiles as described in Methods. Rate of use of surgery was adjusted for patient-, tumor-, and center-level factors as described in Methods.
VATS = video-assisted thoracoscopic surgery.