| Title |
Regionalization and Outcomes of Lung Cancer Surgery in Ontario, Canada
|
|---|---|
| Published in |
Journal of Clinical Oncology, July 2017
|
| DOI | 10.1200/jco.2016.69.8076 |
| Pubmed ID | |
| Authors |
Anna M Bendzsak, Nancy N Baxter, Gail E Darling, Peter C Austin, David R Urbach |
| Abstract |
Purpose Regionalization of complex surgery to high-volume hospitals has been advocated based on cross-sectional volume-outcome studies. In April 2007, the agency overseeing cancer care in Ontario, Canada, implemented a policy to regionalize lung cancer surgery at 14 designated hospitals, enforced by economic incentives and penalties. We studied the effects of implementation of this policy. Methods Using administrative health data, we used interrupted time series models to analyze the immediate and delayed effects of implementation of the policy on the distribution of lung cancer surgery among hospitals, surgical outcomes, and health services use. Results From 2004 to 2012, 16,641 patients underwent surgery for lung cancer. The proportion of operations performed in designated hospitals increased from 71% to 89% after the policy was implemented. Although operative mortality decreased from 4.1% to 2.9% (adjusted odds ratio, 0.68; 95% CI, 0.58 to 0.81; P < .001), the reduction was due to a preexisting declining trend in mortality. In contrast, in the years after implementation of the policy, length of hospital stay decreased more than expected from the baseline trend by 7% per year (95% CI, 5% to 9%; P < .001), and the distance traveled by all patients to the hospital for surgery increased by 4% per year (95% CI, 0% to 8%; P = .03), neither of which were explained by preexisting trends. Analyses limited to patients ≥ 70 years of age demonstrated a reduction in operative mortality (odds ratio, 0.80 per year after regionalization; 95% CI, 0.67 to 0.95; P = .01). Conclusion A policy to regionalize lung cancer surgery in Ontario led to increased centralization of surgery services but was not independently associated with improvements in operative mortality. Improvements in length of stay and in operative mortality among elderly patients suggest areas where regionalization may be beneficial. |
X Demographics
The data shown below were collected from the profiles of 16 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Canada | 5 | 31% |
| United States | 3 | 19% |
| United Kingdom | 1 | 6% |
| Italy | 1 | 6% |
| Spain | 1 | 6% |
| Unknown | 5 | 31% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 7 | 44% |
| Scientists | 6 | 38% |
| Practitioners (doctors, other healthcare professionals) | 3 | 19% |
Mendeley readers
The data shown below were compiled from readership statistics for 47 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 47 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 7 | 15% |
| Student > Doctoral Student | 6 | 13% |
| Student > Bachelor | 5 | 11% |
| Student > Master | 5 | 11% |
| Student > Postgraduate | 4 | 9% |
| Other | 6 | 13% |
| Unknown | 14 | 30% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 18 | 38% |
| Nursing and Health Professions | 3 | 6% |
| Biochemistry, Genetics and Molecular Biology | 2 | 4% |
| Agricultural and Biological Sciences | 2 | 4% |
| Economics, Econometrics and Finance | 2 | 4% |
| Other | 2 | 4% |
| Unknown | 18 | 38% |
Attention Score in Context
This research output has an Altmetric Attention Score of 19. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 21 February 2019.
All research outputs
#1,930,559
of 25,382,440 outputs
Outputs from Journal of Clinical Oncology
#4,644
of 22,051 outputs
Outputs of similar age
#36,568
of 326,018 outputs
Outputs of similar age from Journal of Clinical Oncology
#95
of 153 outputs
Altmetric has tracked 25,382,440 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 92nd percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 22,051 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 21.0. This one has done well, scoring higher than 78% of its peers.
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