Community Size and Lung Cancer Resection Outcomes: Studying the Society of Thoracic Surgery Database

Abstract Background Socioeconomic factors play key roles in surgical outcomes. Socioeconomic data within the Society of Thoracic Surgery General Thoracic Surgery Database (STS GTSD) is limited. Therefore, we utilized community size as a surrogate to understand socioeconomic differences in lung cancer resection outcomes. Methods We retrospectively reviewed all lung cancer resections from January 2012 to January 2017 in the STS GTSD. This captured 68,722 patients from 286 centers nationwide. We then linked patient zip codes with 2013 Rural Urban Continuum Codes (RUCC) to understand the association between community size and postoperative outcomes. Demographic and clinical variables were evaluated for relationships with 30-day mortality, major morbidity, and readmission. Results Zip codes were included in 47.2% of patients. Zip coded patients were older, more comorbid, with less advanced disease, and more commonly treated with minimally invasive approaches than those without zip code classification. For geocoded patients, multivariable analyses demonstrated that sex, insurance payor, and hospital region were associated with all three major endpoints. Community size, based on RUCC coding, was not associated with any primary endpoint. Invasive mediastinal staging was related to morbidity, greater pathological stage predicted mortality, and worsened clinical stage was associated with readmission. More invasive surgery and greater extent of lung resection were associated with all primary endpoints. Conclusions Incomplete data capture can promote selection bias within the STS GTSD and skew outcomes reporting. Moreover, community size is an insufficient surrogate, compared to sex, insurance payor, hospital region, for understanding socioeconomic differences in lung cancer resection outcomes.