RESUMEN
OBJECTIVE: Presentation of an experience in benchmarking in 13 university Spanish thoracic surgery services. METHODS: The minimum basic data set (MBDS) for hospitalization, corresponding to 2007, including all registered hospital discharges, was used. The performance of the hospitals was compared using an external reference pattern (SN) and internal average (BMG). Cases were chosen in which a major pulmonary resection (lobectomy or pneumonectomy) was done for bronchogenic carcinoma. Performance indicators were the complexity of the casuistry (average weight and relative weight). Performance results indicators included average length of stay (preoperative, postoperative, and global lengths of stay were analyzed separately for lobectomies as well as pneumonectomies), complications, mortality, and urgent readmissions. RESULTS: A total number of 4778 cases were analyzed, with major thoracic surgeries being prominent with 1779 (37.3%). For average weight, there was a dispersion between 2.5 and 5.68, with an average of 3.45 for the BMG and 3.43 for the SN. There were some very significant differences in morbidity, with groups having a gross rate of few complications (2.6%) up to many (16.1%). The mortality rate ranged between 1.6% and 6.6%. There were considerable differences in urgent readmissions, with gross rates between 2.6% and 7.3%, considering as points of reference 5.4% (BMG) and 4.7% (SN). Concerning the results of pulmonary resections for bronchogenic carcinoma, the index of pneumonectomies was between 8% and 29%. The average length of stay for lobectomy was between 6 and 9.5, with an average of 7 in BMG. In the case of pneumonectomies, it was between 6 and 26 days, with an average of 9 for BMG. Average preoperative stay also varied widely, between 0.2 and 2.4, while postoperative stay was between 7.5 and 12.1. The gross global rate of complications ranged from 2.7% to 36.7%, with points of reference of 15.6% (BMG) and 13.8% (SN). The complication rate ranged from 3% to 33%, with an average of 14.5% for lobectomies, with higher variability for pneumonectomies (0-58%). CONCLUSIONS: Benchmarking could be an effective method for improving clinical management. A considerable variability was detected in our study among the participating groups.
Asunto(s)
Benchmarking , Procedimientos Quirúrgicos Torácicos/normas , Carcinoma Broncogénico/cirugía , Femenino , Investigación sobre Servicios de Salud/métodos , Mortalidad Hospitalaria , Hospitales Universitarios/normas , Humanos , Tiempo de Internación/estadística & datos numéricos , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Neumonectomía/efectos adversos , Neumonectomía/normas , Complicaciones Posoperatorias/epidemiología , Indicadores de Calidad de la Atención de Salud , España/epidemiologíaRESUMEN
The incidence of lung cancer has been increasing in developed countries since the mid-1990s. The main objective of this study is to determine if bronquial stump infiltration can affect survival in patients with lung cancer. For this purpose, we differentiate between carcinoma 'in situ' and invasive carcinoma. We included patients suffering from non-small cell lung cancer who underwent thoracothomy as treatment. The total number of patients was 2994. In this study, 80 patients out of the 2994 had bronchial stump affection. Eight patients were excluded thus a total of 72 patients were included, 52 of them had carcinoma 'in situ' and 20 invasive carcinoma. The global survival was 25 months. Patients with carcinoma 'in situ' had a median survival of 25 months as opposed to 21 months in patients with invasive carcinoma. We only found statistical significance when we compared the histology with the type of bronchial stump infiltration. We did not observe statistical significance in survival between carcinoma 'in situ' and invasive carcinoma bronchial stump infiltration (P=0.094). The only survival predictor variable is histology (adenocarcinoma), P=0.0001.
Asunto(s)
Adenocarcinoma/cirugía , Bronquios/cirugía , Carcinoma in Situ/cirugía , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Carcinoma de Células Escamosas/cirugía , Neoplasias Pulmonares/cirugía , Toracotomía , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Bronquios/patología , Carcinoma in Situ/mortalidad , Carcinoma in Situ/patología , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Femenino , Humanos , Estimación de Kaplan-Meier , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , Neoplasia Residual , Modelos de Riesgos Proporcionales , Sistema de Registros , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , España/epidemiología , Factores de Tiempo , Resultado del TratamientoRESUMEN
Gene methylation and K-ras mutations were examined in tumor and paired serum DNA of 50 resected non-small-cell lung cancer patients. RASSF1A, death associated protein kinase and target of methylation-induced silencing were methylated in 17/50 (34%), 23/50 (45%) and 18/50 (35%) tumors, respectively, and in 17/50 (34%), 20/50 (40%) and 17/50 (34%) sera, respectively. Methylation in tumor and serum were closely correlated (P=0.001), but no correlation was found with survival. Twelve K-ras mutations (cysteine) were found in serum and nine mutations were found in tumor (five cysteine, one alanine, one aspartic, one arginine, and one valine). K-ras mutations in serum correlated significantly with survival (P=0.01).