The Association of Short-Term Outcomes and Long-Term Survival After Lung Cancer Resection.

Abstract

Quality metrics that compare care across institutions are typically based on short-term outcomes. This study evaluated whether short-term quality metrics for non-small cell lung cancer (NSCLC) resections predict long-term survival.Centers in the National Cancer Database that performed = 30 NSCLC resections between 2010-2019 were ranked based on major postoperative morbidity, defined as a weighted composite of 30-day mortality, unplanned readmissions, and hospital stays longer than 14 days. Centers were stratified by morbidity rates into quintiles, with the top quintile designated high-quality. The impact of care at high-quality institutions on survival was assessed with Kaplan-Meier analysis and Cox proportional hazards modeling.The study included 198,115 patients from 928 centers. High-quality centers had lower 30-day mortality (0.8% [362/47,321] vs 2.4% [3,614/150,794], p<0.001) and morbidity rates (median 5% [Interquartile Range {IQR} 4.0%-5.9%] vs 10.8% [IQR 8.7%-14.0%], p<0.001) than non-high-quality centers. Patients treated at high-quality centers had improved long-term survival compared to other patients in both univariable (5-year survival 71.5% [95% Confidence Interval {CI} 71.0-71.9%] vs 62.6% [95% CI 62.3-62.8%], p<0.0001) and multivariable analysis (hazard ratio [HR] 0.75 [95% CI 0.73-0.77], p<0.001). Sensitivity analysis of stage IA patients treated with lobectomy and no induction therapy showed similar survival benefits to care at high-quality centers in both univariable (5-year survival 79% [95% CI 78.3-79.7%] vs 73.2% [95% CI 72.8-73.6%], p<0.001) and multivariable (HR 0.76 [95% CI 0.73-0.78], p<0.001) analyses.Patients who underwent lung cancer resection at institutions deemed high-quality based on short-term outcomes also had better long-term survival.

View details for DOI 10.1016/j.jtcvs.2025.11.007

View details for PubMedID 41260411