Diffusion of Minimally Invasive Approach for Lung Cancer Surgery in France: A Nationwide, Population-Based Retrospective Cohort Study
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Data Source and Study Population
2.2. Patient Characteristics
2.3. Region and Hospital Characteristics
2.4. Statistical Analysis
3. Results
3.1. Variations in the Use of the Minimally Invasive Approach in Hospitals over Time
3.2. Between-Hospital Variations in Adjusted Minimally Invasive Approach Rates in Each Region of France
4. Discussion
Limitations and Strengths
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Period | |||||
---|---|---|---|---|---|
2013–2014 | 2015–2016 | 2017–2018 | 2019–2020 | p-Value * | |
N | 16,933 | 18,778 | 20,903 | 21,351 | |
Age | |||||
38–56 | 3203 (18.92%) | 3397 (18.09%) | 3336 (15.96%) | 3135 (14.68%) | |
57–61 | 2908 (17.17%) | 3029 (16.13%) | 3219 (15.40%) | 2969 (13.91%) | |
62–65 | 2798 (16.52%) | 2972 (15.83%) | 3134 (14.99%) | 3302 (15.47%) | 0.00001 |
66–69 | 2850 (16.83%) | 3361 (17.90%) | 3836 (18.35%) | 3898 (18.26%) | |
70–74 | 2461 (14.53%) | 2934 (15.62%) | 3814 (18.25%) | 4222 (19.77%) | |
≥75 | 2713 (16.02%) | 3085 (16.43%) | 3564 (17.05%) | 3825 (17.91%) | |
Female | 5460 (32.24%) | 6528 (34.76%) | 7683 (36.76%) | 8407 (39.38%) | 0.00001 |
Modified CCI | |||||
0 | 5829 (34.42%) | 6448 (34.34%) | 7300 (34.92%) | 12,451 (58.32%) | 0.00001 |
1 | 1762 (10.41%) | 1992 (10.61%) | 2387 (11.42%) | 1750 (8.20%) | |
2 | 1785 (10.54%) | 2129 (11.34%) | 2533 (12.12%) | 1918 (8.98%) | |
≥3 | 7557 (44.63%) | 8209 (43.72%) | 8683 (41.54%) | 5232 (24.50%) | |
VATS/RATS | 3841 (22.68%) | 6489 (34.56%) | 9194 (43.98%) | 10,734 (50.27%) | 0.00001 |
Limited | 3085 (18.22%) | 3368 (17.94%) | 3673 (17.57%) | 3583 (16.78%) | 0.0012 |
Lobectomy | 13,848 (81.78%) | 15,410 (82.06%) | 17,230 (82.43%) | 17,768 (83.22%) |
Period | ||||
---|---|---|---|---|
2013–2014 | 2015–2016 | 2017–2018 | 2019–2020 | |
Number of hospitals | 141 | 137 | 134 | 130 |
Type of hospitals | ||||
Non academic | 31 | 32 | 31 | 30 |
Academic | 27 | 27 | 26 | 26 |
Private non-profit | 13 | 10 | 11 | 9 |
Private for profit | 70 | 68 | 66 | 65 |
Hospital volume * | ||||
Non academic | 48 [30–74] | 62 [48–84] | 68 [48–114] | 77 [55–129] |
Academic | 183 [147–386] | 208 [125–380] | 270 [155–443] | 284 [161–426] |
Private non-profit | 125 [35–366] | 246 [85–428] | 225 [31–464] | 258 [188–501] |
Private for profit | 60 [30–103] | 70 [37–124] | 93 [43–153] | 92 [49–158] |
Observed rate of minimally invasive approach ** | ||||
Non academic | 0.042 [0–0.25] | 0.16 [0.04–0.41] | 0.23 [0.05–0.61] | 0.33 [0.03–0.64] |
Academic | 0.11 [0.04–0.31] | 0.29 [0.13–0.57] | 0.46 [0.25–0.66] | 0.56 [0.41–0.68] |
Private non-profit | 0.28 [0.17–0.4] | 0.52 [0.38–0.57] | 0.6 [0.49–0.77] | 0.65 [0.5–0.7] |
Private for profit | 0.11 [0.05–0.31] | 0.23 [0.08- 0.45] | 0.34 [0.18–0.55] | 0.43 [0.17–0.66] |
Overall | 0.12 [0.04–0.31] | 0.26 [0.08–0.5] | 0.37 [0.21–0.61] | 0.47 [0.24–0.68] |
Adjusted rate of minimally invasive approach ** | ||||
Non academic | 0.06 [0.04–0.33] | 0.22 [0.06–0.55] | 0.32 [0.08–0.75] | 0.42 [0.07–0.78] |
Academic | 0.15 [0.06–0.47] | 0.42 [0.18–0.7] | 0.57 [0.31–0.75] | 0.68 [0.53–0.85] |
Private non-profit | 0.41 [0.24–0.55] | 0.65 [0.5–0.79] | 0.65 [0.58–0.82] | 0.77 [0.63–0.8] |
Private for profit | 0.16 [0.08–0.42] | 0.3 [0.12–0.59] | 0.38 [0.23–0.6] | 0.56 [0.22–0.8] |
Overall | 0.12 [0.06–0.43] | 0.35 [0.13–0.66] | 0.45 [0.25–0.74] | 0.58 [0.3–0.8] |
2013–2014 | 2015–2016 | 2017–2018 | 2019–2020 | |||||
---|---|---|---|---|---|---|---|---|
Median [IQR] | Extreme Ratio Interquartile Ratio | Median [IQR] | Extreme Ratio Interquartile Ratio | Median [IQR] | Extreme Ratio Interquartile Ratio | Median [IQR] | Extreme Ratio Interquartile Ratio | |
ARA | 0.43 | 32 | 0.57 | 37 | 0.75 | 15 | 0.8 | 22 |
[0.14–0.74] | 5.29 | [0.35–0.8] | 2.29 | [0.56–0.9] | 1.61 | [0.54–1] | 1.85 | |
BFR | 0.15 | 15 | 0.13 | 15 | 0.31 | 6 | 0.09 | 19 |
[0.05–0.32] | 6.40 | [0.09–0.35] | 3.89 | [0.28–0.32] | 1.14 | [0.08–0.15] | 1.88 | |
BRE | 0.28 | 20 | 0.67 | 20 | 0.66 | 2 | 0.71 | 2 |
[0.09–0.65] | 7.22 | [0.27–0.8] | 2.96 | [0.48–0.83] | 1.73 | [0.58–0.84] | 1.45 | |
CVL | 0.1 | 8 | 0.194 | 10 | 0.31 | 6 | 0.3 | 16 |
[0.08–0.2] | 2.50 | [0.08–0.33] | 4.13 | [0.3–0.37] | 1.23 | [0.14–0.56] | 4.00 | |
GE | 0.075 | 61 | 0.302 | 41 | 0.24 | 25 | 0.39 | 7 |
[0.023–0.21] | 9.13 | [0.11–0.42] | 3.82 | [0.12–0.4] | 3.33 | [0.16–0.64] | 4.00 | |
HdF | 0.12 | 37 | 0.192 | 37 | 0.34 | 27 | 0.51 | 36 |
[0.04–0.33] | 8.25 | [0.11–0.35] | 3.18 | [0.22–0.5] | 2.27 | [0.38–0.6] | 1.58 | |
IdF | 0.24 | 53 | 0.41 | 19 | 0.58 | 24 | 0.63 | 11 |
[0.05–0.7] | 14.00 | [0.13–0.8] | 6.15 | [0.26–0.84] | 3.23 | [0.2–0.93] | 4.65 | |
NA | 0.1 | 35 | 0.132 | 26 | 0.232 | 24 | 0.41 | 32 |
[0.04–0.16] | 4.00 | [0.06–0.27] | 4.50 | [0.08–0.33] | 4.13 | [0.07–0.6] | 8.57 | |
NOR | 0.21 | 143 | 0.435 | 8 | 0.46 | 5 | 0.59 | 6 |
[0.11–0.6] | 5.45 | [0.2–0.66] | 3.30 | [0.32–0.72] | 2.25 | [0.35–0.9] | 2.57 | |
OC | 0.24 | 58 | 0.51 | 25 | 0.462 | 10 | 0.67 | 4 |
[0.12–0.41] | 3.42 | [0.24–0.6] | 2.50 | [0.33–0.73] | 2.21 | [0.57–0.9] | 1.58 | |
PACA | 0.41 | 33 | 0.48 | 6 | 0.624 | 4 | 0.67 | 3 |
[0.15–0.49] | 3.27 | [0.3–0.85] | 2.83 | [0.43–0.76] | 1.65 | [0.53–0.9] | 1.70 | |
PdL | 0.36 | 26 | 0.49 | 18 | 0.6 | 7 | 0.6 | 10 |
[0.11–0.43] | 3.91 | [0.24–0.7] | 2.92 | [0.22–0.78] | 3.55 | [0.18–0.83] | 4.61 |
Coefficient | p-Value | [95% Confidence Interval] | ||
---|---|---|---|---|
Period | ||||
2013–2014 | 0 | |||
2015–2016 | 0.12 | 0.001 | 0.06 | 0.18 |
2017–2018 | 0.18 | 0.001 | 0.12 | 0.24 |
2019–2020 | 0.25 | 0.001 | 0.19 | 0.31 |
Logarithm hospital volume | 0.06 | 0.0001 | 0.03 | 0.09 |
Type of Hospital | ||||
Non-academic | 0 | |||
Academic | 0.06 | 0.1 | −0.014 | 0.15 |
Private non-profit | 0.17 | 0.001 | 0.07 | 0.27 |
Private for-profit | 0.03 | 0.4 | −0.035 | 0.08 |
Variance between regions | 0.015 | |||
Variance within regions | 0.067 | |||
Intraclass correlation coefficient | 0.18 | |||
Explained variation within regions | 0.23 | |||
Explained variation between regions | 0.14 |
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Share and Cite
Bernard, A.; Cottenet, J.; Pages, P.-B.; Quantin, C. Diffusion of Minimally Invasive Approach for Lung Cancer Surgery in France: A Nationwide, Population-Based Retrospective Cohort Study. Cancers 2023, 15, 3283. https://doi.org/10.3390/cancers15133283
Bernard A, Cottenet J, Pages P-B, Quantin C. Diffusion of Minimally Invasive Approach for Lung Cancer Surgery in France: A Nationwide, Population-Based Retrospective Cohort Study. Cancers. 2023; 15(13):3283. https://doi.org/10.3390/cancers15133283
Chicago/Turabian StyleBernard, Alain, Jonathan Cottenet, Pierre-Benoit Pages, and Catherine Quantin. 2023. "Diffusion of Minimally Invasive Approach for Lung Cancer Surgery in France: A Nationwide, Population-Based Retrospective Cohort Study" Cancers 15, no. 13: 3283. https://doi.org/10.3390/cancers15133283