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Minimally Invasive Surgery
Volume 2012, Article ID 760292, 12 pages
Research Article

Surgeons’ Volume-Outcome Relationship for Lobectomies and Wedge Resections for Cancer Using Video-Assisted Thoracoscopic Techniques

1Associate Professor of Health Care Management, The Wharton School, University of Pennsylvania, 202 Colonial Penn Center, 3641 Locust Walk, Philadelphia, PA 19104, USA
2S2 Statistical Solutions, Inc., 11176 Main Street, Cincinnati, OH 45241, USA
3Healthcare Policy and Economics, Ethicon Endo-Surgery, 4545 Creek Road, Cincinnati, OH 45252, USA
4Division of Thoracic Surgery and Surgical Quality, NorthShore University Health System, 2650 Ridge Avenue, 3507 Walgreen Buliding, Evanston, IL 60201, USA
5Division of Thoracic Surgery, Emory University Healthcare, 1365 Clifton Rd NE, Atlanta, GA 30322, USA
6Division of Thoracic Surgery, University of Minnesota, 420 Delaware Street SE, Mayo Mail Code 195, Minneapolis, MN 55455, USA
7Division of Thoracic Surgery, Cedars Sinai Medical Center, 8635 West Third, Suite 675, Los Angeles, CA 90048, USA
8Division of Cardiothoracic Surgery, Barnes-Jewish Hospital Plaza, Washington University in St. Louis, Queeny Tower, Suite 3108, St. Louis, MO 63110-1013, USA
9Division of Minimally Invasive Thoracic Surgey, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA

Received 8 March 2012; Accepted 13 September 2012

Academic Editor: Peng Hui Wang

Copyright © 2012 Guy David et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


This study examined the effect of surgeons’ volume on outcomes in lung surgery: lobectomies and wedge resections. Additionally, the effect of video-assisted thoracoscopic surgery (VATS) on cost, utilization, and adverse events was analyzed. The Premier Hospital Database was the data source for this analysis. Eligible patients were those of any age undergoing lobectomy or wedge resection using VATS for cancer treatment. Volume was represented by the aggregate experience level of the surgeon in a six-month window before each surgery. A positive volume-outcome relationship was found with some notable features. The relationship is stronger for cost and utilization outcomes than for adverse events; for thoracic surgeons as opposed to other surgeons; for VATS lobectomies rather than VATS wedge resections. While there was a reduction in cost and resource utilization with greater experience in VATS, these outcomes were not associated with greater experience in open procedures.