Virtual Library
Start Your Search
W. Lieberman-Cribbin
Author of
-
+
P1.01 - Poster Session with Presenters Present (ID 453)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Epidemiology/Tobacco Control and Cessation/Prevention
- Presentations: 2
- Moderators:
- Coordinates: 12/05/2016, 14:30 - 15:45, Hall B (Poster Area)
-
+
P1.01-029 - Personal and Hospital Factors Associated with Limited Surgical Resection, In-Hospital Mortality and Complications in New York State (ID 5359)
14:30 - 14:30 | Author(s): W. Lieberman-Cribbin
- Abstract
Background:
Lung cancer represents 13.4% of all newly diagnosed US cancers and 27.1% of all cancer deaths. Early stage lung cancer is generally treated with surgical resection. Many patient- and hospital-level factors influence the selection of appropriate surgical procedures and their outcome. We identified patient- and hospital-level characteristics influencing the type of lung cancer surgical approach utilized in New York State and assessed in-hospital complications and mortality.
Methods:
Patients were selected from the Statewide Planning and Research Cooperative System, SPARCS (1995-2012) based on ICD-9-CM codes of diagnosis (162 and 165) and procedures (32.0-32.9). Surgery was categorized into: limited resection (LR: 32.2-32.3), lobectomy (L: 32.4), and pneumonectomy (P: 32.5-32.6). Statistical analyses were performed in SAS v9.4 and ArcMap v10.3.1.
Results:
There were 36,460 patients (age 60-75 years); 56% underwent L, 37% LR, and 7% P. LR patients were more likely to be older (OR~adj~ 1.01, 95%CI [1.01-1.02]), female (OR~adj~ 1.10 [1.06-1.15]), Black (OR~adj~ 1.24 [1.15-1.34]), with comorbidities (OR~adj~ 1.10 [1.04-1.16]) than L patients. Opposite trends were observed among P patients, except for race. Over time, the odds of P decreased, while those of LR significantly increased (OR~adj~ 1.22 [1.16-1.29] for years 2007-2012 vs 1995-2000). Teaching hospitals were less likely to perform LR over L (OR~adj~ 0.82 [0.75-0.88]), while the opposite was true for hospitals with larger surgery volumes (OR~adj~ 1.07[1.03-1.11]). In-hospital complications were significantly less after LR than L (OR~adj~ 0.66 [0.62-0.69]), while in-hospital mortality was similar (OR~adj~ 0.93 [0.84-1.03]). In-hospital mortality was directly associated with age, length of stay, urgent/emergency admission, and inversely associated with female gender, private insurance, and surgery volumes. Figure 1
Conclusion:
There is a growing trend towards LR, which is still more likely to be performed in older patients with co-morbidities. In-hospital outcomes were affected by patients’ clinical and personal characteristics, and were better after LR than L or P.
-
+
P1.01-045 - Patient to Hospital Distance in Access to Care and Lung Cancer Surgical Treatment (ID 4464)
14:30 - 14:30 | Author(s): W. Lieberman-Cribbin
- Abstract
Background:
Lung cancer represents 13.4% of all newly diagnosed US cancers and 27.1% of all cancer deaths. Health disparties exist in accessing proper care and receving surgical treatment. We examined the role of Patient to Hospital distance (P-H) in access to care.
Methods:
Patients were selected from the New York State Statewide Planning and Research Cooperative System (1995-2012) based on ICD-9-CM diagnosis (162 and 165) and procedures (32.0-32.9). Surgery was categorized into: limited resection (LR: 32.2-32.3), lobectomy (L: 32.4), and pneumonectomy (P: 32.5-32.6). Distance calculations (ArcMap 10.3.1) and linear regressions (SAS v9.4) were performed to determine the factors influencing P-H.
Results:
There were 36,460 patients (age 60-75 years); 56% underwent L, 37% LR, and 7% P; 95% of patients underwent surgery at a hospital < 70 kilometres (km) from their home (mean±SD 20.49±30.24 km; median 11.10 km). P-H was shorter in LR (19.10±27.71 km) than L (21.00±30.96 km) and P (23.87±36.56 km; p < 0.001). At multivariable analysis, P-H was positively associated with teaching hospitals (β: 3.33, p < 0.001), admitted during 1995-2000 (β: 1.08, p < 0.001) and 2001-2006 (β: 1.23, p < 0.001), and P (β: 1.57, p < 0.001), and inversely associated with female gender (β: -0.49, p = 0.016), age at admission (β: -0.17, p < 0.001), black race (β: -8.22, p < 0.001), Medicaid (β: -3.37, p < 0.001), private insurance (β: -0.79, p = 0.004), rural hospitals (β: -2.80, p < 0.001), LR (β -0.81, p < 0.001), and mortality (β -1.05, p = 0.081). Similar associations were found in the L subgroup; among LR patients there was no statistically signficant association between P-H and female gender. Figure 1
Conclusion:
Significant differences exist in P-H and patient/hospital characteristics, which may affect type of surgery and outcome. P-H should be incorporated to improve health disparities in accessing surgical care.
