January 30, 2019

‘Regionalizing' cancer surgery leads to better outcomes

Kaiser Permanente research shows specialty centers reduce complications and length of hospital stays

Lung-cancer surgery patients who received care at regional centers where specialty care is concentrated have shorter hospital stays and fewer complications, according to Kaiser Permanente research presented this week at the 55th annual meeting of the Society of Thoracic Surgeons.

“Shifting lung cancer surgery to designated centers within our integrated health system reduced the number of days patients spent in the hospital, decreased intensive care use, and reduced post-operative complications,” said Jeffrey B. Velotta, MD, a thoracic surgeon at Kaiser Permanente Oakland medical center.

Kaiser Permanente regionalized thoracic surgery care in 2014 by shifting cases in Northern California from 16 hospitals to five designated specialty-care centers.

Researchers looked for effects of regionalization by comparing two groups of patients: 782 patients who underwent lung-cancer surgery between 2011 and 2013 (before regionalization) and 845 patients who had surgery between 2015 and 2017 (after regionalization).

The researchers found that regionalization resulted in increased use of minimally invasive, video-assisted thoracoscopic surgery – from 57 percent to 86 percent.

In addition, the average operating time for these types of surgeries decreased by more than 50 minutes after regionalization, possibly due to the surgical team’s efficiency with repetition of these cases.

“In our study, we found that regionalization of lung surgery was indeed feasible within an integrated health system,” said Velotta. “In the post-regionalization era, lung surgeries are performed by more experienced, thoracic-specialized surgeons at higher volume centers.”