T. R. Grenda1, J. R. Thumma1, J. B. Dimick1 1University Of Michigan,Center For Healthcare Outcomes And Policy,Ann Arbor, MI, USA
Introduction: A growing body of evidence has emerged supporting the use of video-assisted thoracoscopic surgery (VATS) in lung cancer resection. While trends towards increased utilization of this approach have been observed, wide variations in use remain. The extent to which geography and hospital factors contribute to this variation remains poorly understood.
Methods: We used national Medicare data (2008-2012) to examine geographic variations in use of VATS for patients undergoing lung cancer resection. We identified patients undergoing open or VATS approach for lung cancer resection and assigned them to hospital referral regions (HRRs) corresponding to where they received treatment. Rates of VATS utilization were calculated for each HRR and quartiles of HRR use were created according to HRR utilization rate. We then evaluated rates of VATS utilization across hospital characteristics and trends in time.
Results: A total of 49,077 patients underwent lung resection across 1,852 hospitals during the study period, with 23,911 (48.7%) resections performed using a VATS approach. Rates of VATS utilization varied dramatically from 0% in the lowest use HRR to 90.6% in the highest use HRR across 306 HRRs. Overall utilization rates increased over time from 32% in 2008 to 50% in 2012 (p<0.001). Mean VATS utilization rates were greater in hospitals with the highest total lung cancer resection volume compared to the lowest volume centers (58% vs 32%, p<0.001). Non-critical access hospitals had a significantly higher utilization rate than critical access hospitals (38% vs. 19%, p=0.04). There was no significant difference in utilization between high-technology and non-technology hospitals (38% vs. 39%, respectively, p=0.51).
Conclusion: Wide geographic variations in the utilization of VATS exist, which may limit a patient’s options for surgical approach based on where they live. Further efforts are needed to understand the main drivers underlying these variations in order to broaden patient access to this technology.