Background. Given the complexity of lung cancer surgery, this study aims to provide an overview of hospitals authorised to perform lung cancer surgery in France, and to assess their performance focusing on severe post-operative complications and 30-day in-hospital mortality based on the Clavien–Dindo classification (grade > 2).Methods. We included all patients (n = 64,304) who underwent pulmonary resection for lung cancer from the French hospital database (2019–2023). To quantify variations within regions, we used the ratio of the 90th to the 10th decile of the standardised outcome rate of the hospitals. We used a hierarchical logistic regression model to estimate the adjusted odds ratio (aOR) according to the number of annual procedures. We then used the results of this modelling to see how the standardised rate estimate might evolve after simulating a new organisation of hospitals authorised to perform this surgery.Results. A total of 18,151 patients (28%) had severe complications (Clavien–Dindo > 2). Compared to hospital performing less than 100 procedures/year, the risk of severe complications was significantly reduced for hospitals performing between 101 and 250 procedures/year (aOR = 0.83 [0.77–0.89]) and more than 250 procedures/year (aOR = 0.85 [0.77–0.93]). A simulation of hospital reorganisation, using 100 procedures/year as the threshold value, showed that 477 severe complications could have been prevented over the period.Conclusions. This study shows inequalities in performance indicators between hospitals in each French region. The influence of the volume of activity raises questions about the need to restructure the offer of care for complex surgeries, such as lung cancer surgery.
背景：鉴于肺癌手术的复杂性，本研究旨在概述法国获准开展肺癌手术的医院情况，并基于Clavien-Dindo分级（>2级）评估其术后严重并发症及30天院内死亡率的表现。 方法：我们从法国医院数据库（2019-2023年）中纳入所有接受肺癌肺切除术的患者（n = 64,304）。为量化地区内差异，我们采用医院标准化结局率的第90与第10百分位数之比。通过分层逻辑回归模型，根据医院年手术量估算调整后的比值比（aOR）。随后利用该模型结果，模拟肺癌手术授权医院重组后标准化率可能发生的变化。 结果：共有18,151例患者（28%）出现严重并发症（Clavien-Dindo > 2级）。与年手术量低于100例的医院相比，年手术量101-250例的医院严重并发症风险显著降低（aOR = 0.83 [0.77-0.89]），年手术量超过250例的医院风险亦显著降低（aOR = 0.85 [0.77-0.93]）。以年手术量100例为阈值进行医院重组模拟显示，研究期间本可避免477例严重并发症。 结论：本研究揭示了法国各区域内医院间绩效指标的差异。手术量对结局的影响引发了对肺癌手术等复杂术式医疗服务体系重构必要性的思考。
肿瘤(癌症)患者之家