Association of hospital volume with perioperative and long-term outcomes of minimally invasive thymectomy

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Background Thymectomy is an uncommon procedure, and operative experience may influence outcomes. We examined the association between center-level operative volume using the National Readmissions Database (NRD) and the National Cancer Database (NCDB). These databases provide complementary insights into short- and long-term outcomes. We hypothesized that perioperative morbidity would be similar in high-volume (HV) centers and low-volume (LV) centers, but long-term survival and R0 resection—especially for minimally invasive (MI) thymectomy—would be superior in HV centers. Methods Patients from the NRD (2017-2020) and NCDB (2010-2015 and 2018-2021) diagnosed with thymoma or thymic carcinoma who underwent thymectomy were included. (NCDB 2016-2017 was excluded for missing stage data.) The top quartile defined HV centers from LV centers. The Pearson χ 2 test was used to calculate odds ratios (OR) and 95% confidence intervals (CIs). Logistic regression assessed factors associated with in-hospital mortality, postoperative complications, and R0 resection. Kaplan-Meier analysis evaluated long-term survival. Results In NRD analysis (n = 3127 patients), MI thymectomy was more frequent in HV centers (57.4% vs 40.9%: P < .001). No differences were found in adjusted 30-day mortality (OR, 2.00; 95% CI, 0.69-5.77; P = .20) or postoperative complications (OR, 0.95; 95% CI, 0.76-1.19; P = .65). In NCDB analysis (n = 3798 patients) HV centers were associated with improved 10-year survival (hazard ratio [HR], 0.77; 95% CI, 0.61-0.97; P = .02) and decreased R1/R2 resection (HR, 0.77; 95% CI, 0.64-0.92; P = .004). MI thymectomies at HV centers were associated with a higher rate of R0 resection for stage I and stage II disease (HR, 0.47 [95% CI, 0.31-0.73; P = .001] and HR, 0.77 [95% CI, 0.64-0.97; P = .004], respectively). Conclusions Perioperative outcomes were similar irrespective of center volume, but HV centers demonstrated improved rates of R0 resection and long-term survival even with an MI approach to thymectomy.

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