Using these explanatory variables, multivariable models were estimated to isolate the effects of a surgeon’s VATS volume on adverse events, hospital costs, surgery time, and length of stay. Because the cost http://www.selleckchem.com/products/crenolanib-cp-868596.html and utilization variables were right skewed, they were converted to natural logarithms to normalize their distributions, although the results were not sensitive to this transformation. Missing data or values of zero were not included in the OLS regression models. Weights provided in the Premier database were used to transform the results in a manner that permitted generalizability to the USA population. All analyses were performed using Stata Version 10 (StataCorp LP, College Station, Texas, USA). 3.

Results Of 7,137 patients in the database with elective, inpatient resections for lung cancer, a total of 2,698 patients underwent lobectomy (n = 716) or wedge resection (n = 1982) using VATS. More than 70% of these procedures were performed by thoracic surgeons (n = 1,896). A patient attrition diagram is shown in Figure 1. Characteristics of eligible patients are summarized in Table 1. There were slightly more females than males in all four samples, and most patients in all samples were over 60 years of age and covered by Medicare. Most patients were Caucasian, with primary (as opposed to metastatic) neoplasm of the lung and only minimal to moderate illness severity level, as measured by the APR-DRG severity index. As expected, the severity index for patients undergoing lobectomy was higher than for patients undergoing wedge resection.

Patient characteristics within procedure (lobectomy versus wedge resection) were similar across the thoracic surgeons sample and the all surgeons sample. Figure 1 Attrition diagram. Thoracotomy: open versus VATS. Table 1 Patient characteristics. The distribution of specific patient comorbidities is shown in Table 2. The most frequent comorbidities reported were chronic obstructive pulmonary disease (COPD), diabetes mellitus, and heart disease. The distribution of these conditions is similar across all samples. Table 2 Comorbid conditions*, **. A total of 237 hospitals contributed data on VATS lobectomies and wedge resections. Patient-weighted hospital characteristics for the four samples are reported in Table 3.

Compared with patients undergoing VATS wedge resection, patients undergoing VATS lobectomy Batimastat were more likely to receive the procedure in a teaching hospital (63% versus 57%) and in a hospital with over 600 beds (46% versus 38%). All samples exhibit similar demographic distributions. Table 3 Hospital characteristics. Average hospital costs, surgery time, length of hospital stay, the likelihood, and number of adverse events, as well as the surgeons’ volume measures for each sample were examined prior to multivariable modeling.