There are significant variations in both perioperative and long-term outcomes after lung cancer resection. While perioperative outcomes are often used as comparative measures of quality, they are unreliable, and their association with long-term outcomes remain unclear. In this context, we evaluated whether historical perioperative mortality after lung cancer resection is associated with 5-year survival. The National Cancer Database (NCDB) was queried to identify patients diagnosed with non-small cell lung cancer (NSCLC) in 2010–2016 who underwent surgical resection (n = 234200). Hospital-level reliability-adjusted 90-day mortality rate quartiles for 2010–2013 was used as the independent variable to analyze 5-year survival for patients diagnosed in 2014–2016 (n = 85396). There were 85,396 patients in the 2014–2016 cohort across 1,086 hospitals. Overall observed 90-day mortality rate was 3.2% (SD 17.6%) with 2.6% (SD 16.0%) for the historically best performing quartile vs. 3.9% (SD 19.4%) for the worst performing quartile (p < 0.0001). Patients who underwent resection at hospitals with the best historical mortality rate had significantly better 5-year survival across all stages compared to those treated at hospitals in the worst performing quartile in multivariate Cox regression analysis (all stages – HR 1.21 [95% CI 1.15–1.26]; stage I – HR 1.19 [95% CI 1.12–1.25]; stage II – HR 1.20 [95% CI 1.09–1.32]; stage III – HR 1.36 [95% CI 1.20–1.54]) and Kaplan-Meier survival estimates (all stages – p < 0.0001, stage I – p < 0.0001; stage II – p = 0.0004; stage III – p < 0.0001). With expanded lung cancer screening criteria and likely increase in early-stage detection, profiling performance is paramount to ensuring mortality benefits. We found that episodes surrounding surgical resection may be used to profile long-term outcomes that likely reflect quality across a broader context of care. Evaluating lung cancer care quality using perioperative outcomes may be useful in profiling provider performance and guiding value-based payment policies.

中文翻译：

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手术质量与肺癌长期生存之间的关系

肺癌切除术后的围手术期和长期结果存在显着差异。虽然围手术期结果经常被用作质量的比较指标，但它们不可靠，并且与长期结果的关系仍不清楚。在这种背景下，我们评估了肺癌切除后历史围手术期死亡率是否与 5 年生存率相关。查询国家癌症数据库 (NCDB) 以确定 2010 年至 2016 年诊断为非小细胞肺癌 (NSCLC) 并接受手术切除的患者 (n = 234200)。使用2010-2013年医院级别可靠性调整的90天死亡率四分位数作为自变量来分析2014-2016年诊断的患者的5年生存率（n = 85396）。 2014-2016 年队列中有 1,086 家医院的 85,396 名患者。观察到的总体 90 天死亡率为 3.2% (SD 17.6%)，历史上表现最好的四分位数为 2.6% (SD 16.0%)，而表现最差的四分位数为 3.9% (SD 19.4%) (p < 0.0001)。在多元 Cox 回归分析中，与在表现最差四分位数的医院接受治疗的患者相比，在历史死亡率最高的医院接受切除的患者在所有阶段的 5 年生存率均显着提高（所有阶段 – HR 1.21 [95% CI 1.15 – 1.26]；I 期 – HR 1.19 [95% CI 1.12–1.25]；II 期 – HR 1.20 [95% CI 1.09–1.32]；III 期 – HR 1.36 [95% CI 1.20–1.54]）和 Kaplan-Meier 生存估计（所有阶段 - p < 0.0001，阶段 I - p < 0.0001；阶段 II - p = 0.0004；阶段 III - p < 0.0001）。随着肺癌筛查标准的扩大以及早期检测可能的增加，分析性能对于确保死亡率效益至关重要。我们发现，围绕手术切除的事件可用于描述长期结果，这些结果可能反映更广泛的护理背景下的质量。使用围手术期结果评估肺癌护理质量可能有助于分析提供者的绩效并指导基于价值的支付政策。