Geographic Variability in Video Assisted Thoracic Surgery Adoption: A MedPAR Medicare Analysis of Lobectomy for Primary Lung Cancer
Justin D. Blasberg, James D. Maloney, Ryan A. Macke. University of Wisconsin Hospital and Clinics, Madison, WI USA.
Objective: VATS lobectomy has slowly become an accepted surgical approach for lung cancer treatment. However, recent reports indicate less than half of lobectomies are performed by VATS, despite evidence supporting oncologic efficacy and decreased morbidity. We examined nationwide lobectomy trends to identify predictors of VATS adoption (Figure SA10-1).
Methods: MedPAR Medicare hospital data (2010 to 2012) was used to identify principal procedures for lobectomy (ICD-9 codes 32.41-VATS, 32.49-open, MS-DRG codes 163,164,165) for primary lung cancer. Data was stratified by region according to Medicare Provider ID. Descriptive analytics were performed to identify geographic variation and institutional characteristics.
Results: In 2012, 15,114 lobectomies were performed in 1832 hospitals (39.6% by VATS). Low-volume hospitals performing ‰¤ 10 lobectomies annually (1366 hospitals,74.6%) had lower VATS adoption rates (27.3%,1206/4418 lobectomies) compared to high-volume hospitals (44.6%,4773/10969 lobectomies,p<0.001). Proportion of VATS versus open lobectomies varied by region: Northeast (53.3%,41.3-65.5%), Midwest (30.0%,0-40.7%), South (39.4%,7.7-55.5%), and West (38.5%,15.4-55.2%). Northeast hospitals with resident training programs, within large cities (>500,000 people), and in the top 10% by volume (>30 lobectomies annually) had VATS adoption rates of 73.2% (62.4-84.4%). Northeast data trended from 2010 to 2012 demonstrated increased VATS utilization in high-volume centers and stagnant adoption in low-volume centers.
Conclusions: There is wide variation in VATS utilization, with increased adoption rates in high-volume centers and institutions with resident training programs. Variability in VATS utilization is greatest when comparing hospital setting, region, and volume. Increased efforts to educate lower-volume surgeons in rural and non-teaching hospitals are needed if increased VATS adoption is expected.