Surgical resection is the main curative modality for non-small cell lung cancer (NSCLC), but variation in the quality of care contributes to sub-optimal survival rates. Improving surgical outcomes by eliminating quality deficits is a key strategy for improving population-level lung cancer survival. We evaluated the long-term survival impact of providing direct feedback on institutional performance in a population-based cohort.

The Mid-South Quality of Surgical Resection cohort includes all NSCLC resections at 11 hospitals in 4 contiguous Dartmouth Hospital Referral Regions in Arkansas, Mississippi, and Tennessee. We evaluated resections from 2004-2013, before and after onset of a benchmarked performance feedback campaign to surgery and pathology teams in 2009.

We evaluated 2,206 patients: 56% pre- and 44% post-intervention. Preoperative PET/CT (46% vs. 82%, p<0.0001), brain scans (6% vs. 21%, p<0.0001), and bronchoscopy (8% vs. 27%, p<0.0001), were more frequently used in the post-era. Patients in the pre-era had 47% (44%- 50%) 5-year survival, compared to 53% (50%-56%) in the post-era (p=0.0028). The post-era had an adjusted hazard ratio of 0.85 (0.75-0.97; p= 0.0158) compared to the pre-era. This differed by extent of resection (p=0.0113): compared to pre-era, the post-era adjusted hazard ratio was 0.49 (0.33-0.72) in pneumonectomy, 0.91 (0.79-1.05) in lobectomy/bilobectomy, and 0.85 (0.63-1.15) in segmentectomy/wedge resections.

Overall survival after surgical resection improved significantly in a high lung cancer mortality region of the United States, reasons may include better selection of patients for pneumonectomy and more thorough staging.