Regionalization and Lung Cancer Operative Mortality in Ontario, Canada


Key Points

  • A reduction in operative mortality reflected trends present prior to regionalization.
  • Regionalization was associated with a reduced length of hospital stay and operative mortality in older patients.

In a study reported in the Journal of Clinical Oncology, Bendzsak et al found that centralization of surgery services to high-volume hospitals in Ontario was not independently associated with improved operative mortality rates in lung cancer.

In April 2007, a policy was implemented to regionalize lung cancer surgery at 14 designated hospitals in Ontario, with the policy enforced by economic incentives and penalties.

Changes With Regionalization

From 2004 to 2012, 16,641 patients in Ontario underwent surgery for lung cancer. The proportion of surgeries performed in designated hospitals increased from 71% to 89% after policy implementation. Operative mortality decreased from 4.1% to 2.9% (adjusted odds ratio [OR] = 0.68, P < .001); however, the difference was not statistically significant after adjustment for secular trends in operative mortality before the introduction of the policy.

Changes not explained by existing trends at the time of regionalization included a decrease in mean length of hospital stay (7% per year, P < .001) and an increase in mean distance traveled for surgery (4% per year, P = .03). In addition, analysis limited to patients aged ≥ 70 years indicated a significant reduction in operative mortality (OR = 0.80 per year after regionalization, P = .01).

The investigators concluded: “A policy to regionalize lung cancer surgery in Ontario led to increased centralization of surgery services but was not independently associated with improvements in operative mortality. Improvements in length of stay and in operative mortality among elderly patients suggest areas where regionalization may be beneficial.”

The study was supported by the Ontario Institute for Cancer Research and Cancer Care Ontario through funding from the Government of Ontario.

David R. Urbach, MD, of the University of Toronto, is the corresponding author of the Journal of Clinical Oncology article.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.