In the latest medical study showing experience counts, researchers found that lung cancer patients survive longer if they have surgery at hospitals that do the operation frequently.
Patients treated at such high-volume hospitals also had far fewer complications and went home a day or two faster.
Expertise and experience probably improves not just the surgery, but the care before and after, said Dr. Peter P. Bach, a lung specialist and professor of epidemiology at Memorial Sloan-Kettering Cancer Center in New York.
Studies of heart surgery and treatments for a variety of other medical conditions likewise have shown that practice makes perfect. However, earlier studies on lung surgery followed patients only briefly.
In the latest study, researchers at Sloan-Kettering looked at 2,118 patients who had lung cancer surgery at 76 U.S. hospitals from 1985 through 1996. Most had an early stage of the most common lung cancer, non-small-cell lung cancer.
Doctors at the 34 lowest-volume hospitals performed only one to eight of the operations each year on average, while those at the two highest-volume hospitals did 67 to 100 annually.
The patients were followed for five years on average. Of those treated at the highest-volume hospitals, 44 percent survived five years and only 3 percent died within 30 days. At the lowest-volume hospitals, only 33 percent lived five years and 6 percent died within a month.
Forty-four percent of patients at the lowest-volume hospitals had complications, compared with 20 percent at the highest-volume hospitals.
Patient survival rates were higher at teaching hospitals than at nonteaching ones.
The research was reported in Thursdays New England Journal of Medicine.
Some researchers suggest that lung cancer operations be limited to hospitals with the best records, but Bach disagreed. And Kate OBrien, an epidemiologist with the American Cancer Society, said such a practice would harm the quality of care.
She said the society is trying to determine which factors bring the best results, to help all hospitals improve.
Lung cancer, Americas top cancer killer, strikes about 170,000 people and kills nearly as many each year. About one in five patients has surgery to remove some or all of a lung.
American Cancer Society: http://www.cancer.org
American Lung Association: http://www.lungusa.org/diseases/lungcanc.html
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