Long-Term Impact of Regionalization of Thoracic Oncology Surgery

Jordan Crosina; Frances Wright; Jonathan Irish; Mohammed Rashid; Tharsiya Martin; Dhruvin H Hirpara; Amber Hunter; Sudhir Sundaresan

doi:10.1016/j.athoracsur.2024.10.002

Long-Term Impact of Regionalization of Thoracic Oncology Surgery

Ann Thorac Surg. 2024 Oct 21:S0003-4975(24)00871-3. doi: 10.1016/j.athoracsur.2024.10.002. Online ahead of print.

Authors

Jordan Crosina¹, Frances Wright², Jonathan Irish³, Mohammed Rashid⁴, Tharsiya Martin⁴, Dhruvin H Hirpara⁵, Amber Hunter⁴, Sudhir Sundaresan⁶

Affiliations

¹ Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.
² Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Division of General Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
³ Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada; Division of Head and Neck Oncology and Reconstructive Surgery, University Health Network, Toronto, Ontario, Canada.
⁴ Ontario Health (Cancer Care Ontario), Toronto, Ontario, Canada.
⁵ Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
⁶ Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada; Division of Thoracic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada. Electronic address: [email protected].

PMID: 39442904
DOI: 10.1016/j.athoracsur.2024.10.002

Abstract

Background: In 2007, Cancer Care Ontario created Thoracic Surgical Oncology Standards for the delivery of surgery, including lobectomy, esophagectomy, and pneumonectomy. These standards regionalized thoracic surgery into designated centers and mandated physical and human resources. This analysis sought to identify the impact of these standards, hereafter referred to as "regionalization," on outcomes after thoracic oncology surgery in Ontario, Canada.

Methods: This study was a population-level analysis of patients undergoing lobectomy, esophagectomy, or pneumonectomy, and it used multilevel regression models to compare 30- and 90-day mortality and length of stay before, during, and after regionalization. Interrupted time series models were used to assess for an impact of regionalization while controlling for ongoing trends.

Results: A total of 22,195 surgical procedures (14,902 lobectomies, 4958 esophagectomies, and 2408 pneumonectomies) were performed within the study period. A total of >99% of cases were performed at a designated center after regionalization. Mean annual volumes per designated center increased after regionalization for lobectomy and esophagectomy and decreased for pneumonectomy. The 30- and 90-day mortality and length of stay improved for lobectomy and esophagectomy over the study period, as did 90-day mortality for pneumonectomy. However, the interrupted time series analysis did not demonstrate any statistically significant effect of regionalization on these outcomes, separate from preexisting trends.

Conclusions: Consistent improvements in mortality and length of stay in thoracic surgical oncology occurred on a provincial level between 2003 and 2020, although this analysis does not attribute these improvements to implementation of Thoracic Surgical Oncology Standards including regionalization.