Dissemination and Implementation Science in Cardiothoracic Surgery: A Review and Case Study

Heiden, Brendan T.; Tetteh, Emmanuel; Robbins, Keenan J.; Tabak, Rachel G.; Nava, Ruben G.; Marklin, Gary; Kreisel, Daniel; Meyers, Bryan F.; Kozower, Benjamin D.; McKay, Virginia

doi:10.1016/j.athoracsur.2021.08.007

Cited by 15 publications

(13 citation statements)

References 66 publications

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“…Although we found that adherence to these QMs did improve over time within the VHA, we still identified wide variability even in a modern cohort of patients through 2019. Our findings clearly indicate that further efforts are needed to improve the dissemination and implementation of guideline-concordant practices in thoracic surgery to improve lung cancer outcomes in both VHA and non-VHA settings …”

Section: Discussionmentioning

confidence: 75%

“…Our findings clearly indicate that further efforts are needed to improve the dissemination and implementation of guideline-concordant prac- tices in thoracic surgery to improve lung cancer outcomes in both VHA and non-VHA settings. 23 Efforts to improve surgical quality, such as through the optimization of the VALCAN-O components, may be particularly fruitful within a closed practice environment like the VHA. The VHA has recently invested substantial resources into dissemination and implementation efforts, including through the creation of institutes like the Center for Evaluation and Implementation Resources.…”

Section: Discussionmentioning

confidence: 99%

“…For example, steep learning curves related to video-assisted thoracic surgery have been associated with poor adoption of minimally invasive lung cancer resection; similarly, various clinician- and patient-specific factors have been associated with inadequate nodal sampling . Collectively, these barriers highlight the challenge of disseminating and implementing evidence-based, guideline-concordant practice standards within thoracic surgery …”

Section: Introductionmentioning

confidence: 99%

“…22 Collectively, these barriers highlight the challenge of disseminating and implementing evidence-based, guideline-concordant practice standards within thoracic surgery. 23 The Veterans Health Administration (VHA) is the largest integrated health care system in the US. 24 Although the VHA serves a unique patient population, 25,26 patterns of lung cancer care (including rates of adherence to intraoperative QMs) and outcomes are similar between veterans and the general US population.…”

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confidence: 99%

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Association Between Surgical Quality Metric Adherence and Overall Survival Among US Veterans With Early-Stage Non–Small Cell Lung Cancer

et al. 2023

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ImportanceSurgical resection remains the preferred treatment for functionally fit patients diagnosed with early-stage non–small cell lung cancer (NSCLC). Process-based intraoperative quality metrics (QMs) are important for optimizing long-term outcomes following curative-intent resection.ObjectiveTo develop a practical surgical quality score for patients diagnosed with clinical stage I NSCLC who received definitive surgical treatment.Design, Setting, and ParticipantsThis retrospective cohort study used a uniquely compiled data set of US veterans diagnosed with clinical stage I NSCLC who received definitive surgical treatment from October 2006 through September 2016. The data were analyzed from April 1 to September 1, 2022. Based on contemporary treatment guidelines, 5 surgical QMs were defined: timely surgery, minimally invasive approach, anatomic resection, adequate lymph node sampling, and negative surgical margin. The study developed a surgical quality score reflecting the association between these QMs and overall survival (OS), which was further validated in a cohort of patients using data from the National Cancer Database (NCDB). The study also examined the association between the surgical quality score and recurrence-free survival (RFS).ExposuresSurgical treatment of early-stage NSCLC.Main Outcomes and MeasuresOverall survival and RFS.ResultsThe study included 9628 veterans who underwent surgical treatment between 2006 and 2016. The cohort consisted of 1446 patients who had a mean (SD) age of 67.6 (7.9) years and included 9278 males (96.4%) and 350 females (3.6%). Among the cohort, 5627 individuals (58.4%) identified as being smokers at the time of surgical treatment. The QMs were met as follows: timely surgery (6633 [68.9%]), minimally invasive approach (3986 [41.4%]), lobectomy (6843 [71.1%]) or segmentectomy (532 [5.5%]), adequate lymph node sampling (3278 [34.0%]), and negative surgical margin (9312 [96.7%]). The median (IQR) follow-up time was 6.2 (2.5-11.4) years. An integer-based score (termed the Veterans Affairs Lung Cancer Operative quality [VALCAN-O] score) from 0 (no QMs met) to 13 (all QMs met) was constructed, with higher scores reflecting progressively better risk-adjusted OS. The median (IQR) OS differed substantially between the score categories (score of 0-5 points, 2.6 [1.0-5.7] years of OS; 6-8 points, 4.3 [1.7-8.6] years; 9-11 points, 6.3 [2.6-11.4] years; and 12-13 points, 7.0 [3.0-12.5] years; P &lt; .001). In addition, risk-adjusted RFS improved in a stepwise manner between the score categories (6-8 vs 0-5 points, multivariable-adjusted hazard ratio [aHR], 0.62; 95% CI, 0.48-0.79; P &lt; .001; 12-13 vs 0-5 points, aHR, 0.39; 95% CI, 0.31-0.49; P &lt; .001). In the validation cohort, which included 107 674 nonveteran patients, the score remained associated with OS.Conclusions and RelevanceThe findings of this study suggest that adherence to intraoperative QMs may be associated with improved OS and RFS. Efforts to improve adherence to surgical QMs may improve patient outcomes following curative-intent resection of early-stage lung cancer.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Association Between Surgical Quality Metric Adherence and Overall Survival Among US Veterans With Early-Stage Non–Small Cell Lung Cancer

et al. 2023

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“…), and have produced scores with suboptimal performance 8,9 . In addition, these tools have been rarely adopted into routine clinical practice 10 . Furthermore, prior models have assessed 30-day mortality despite a growing body of evidence suggesting that broader time horizons—like 90-day mortality—are more accurate metrics of operative risk 11 .…”

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confidence: 99%

Development and Validation of the VA Lung Cancer Mortality (VALCAN-M) Score for 90-Day Mortality Following Surgical Treatment of Clinical Stage I Lung Cancer

et al. 2022

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Objective: The aim was to develop and validate the Veterans Administration (VA) Lung Cancer Mortality (VALCAN-M) score, a risk prediction model for 90-day mortality following surgical treatment of clinical stage I nonsmall-cell lung cancer (NSCLC). Background: While surgery remains the preferred treatment for functionally fit patients with early-stage NSCLC, less invasive, nonsurgical treatments have emerged for high-risk patients. Accurate risk prediction models for postoperative mortality may aid surgeons and other providers in optimizing patient-centered treatment plans. Methods: We performed a retrospective cohort study using a uniquely compiled VA data set including all Veterans with clinical stage I NSCLC undergoing surgical treatment between 2006 and 2016. Patients were randomly split into derivation and validation cohorts. We derived the VALCAN-M score based on multivariable logistic regression modeling of patient and treatment variables and 90-day mortality. Results: A total of 9749 patients were included (derivation cohort: n=6825, 70.0%; validation cohort: n=2924, 30.0%). The 90-day mortality rate was 4.0% (n=390). The final multivariable model included 11 factors that were associated with 90-day mortality: age, body mass index, history of heart failure, forced expiratory volume (% predicted), history of peripheral vascular disease, functional status, delayed surgery, American Society of Anesthesiology performance status, tumor histology, extent of resection (lobectomy, wedge, segmentectomy, or pneumonectomy), and surgical approach (minimally invasive or open). The c statistic was 0.739 (95% CI=0.708–0.771) in the derivation cohort. Conclusions: The VALCAN-M score uses readily available treatment-related variables to reliably predict 90-day operative mortality. This score can aid surgeons and other providers in objectively discussing operative risk among high-risk patients with clinical stage I NSCLC considering surgery versus other definitive therapies.

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Research designs for cardiothoracic surgeons: part 1 — a primer for evidence-based practice

Ahmed

2024

Indian J Thorac Cardiovasc Surg

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Dissemination and Implementation Science in Cardiothoracic Surgery: A Review and Case Study

Cited by 15 publications

References 66 publications

Association Between Surgical Quality Metric Adherence and Overall Survival Among US Veterans With Early-Stage Non–Small Cell Lung Cancer

Association Between Surgical Quality Metric Adherence and Overall Survival Among US Veterans With Early-Stage Non–Small Cell Lung Cancer

Development and Validation of the VA Lung Cancer Mortality (VALCAN-M) Score for 90-Day Mortality Following Surgical Treatment of Clinical Stage I Lung Cancer

Research designs for cardiothoracic surgeons: part 1 — a primer for evidence-based practice

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