Variation in Hospital Adoption Rates of Video-Assisted Thoracoscopic Lobectomy for Lung Cancer and the Effect on Outcomes Zaid M. Abdelsattar, MD, MS,

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Variation in Hospital Adoption Rates of Video-Assisted Thoracoscopic Lobectomy for Lung Cancer and the Effect on Outcomes Zaid M. Abdelsattar, MD, MS, Mark S. Allen, MD, K. Robert Shen, MD, Stephen D. Cassivi, MD, Francis C. Nichols, MD, Dennis A. Wigle, MD, PhD, Shanda H. Blackmon, MD, MPH The Annals of Thoracic Surgery Volume 103, Issue 2, Pages 454-460 (February 2017) DOI: 10.1016/j.athoracsur.2016.08.091 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Variation in risk-adjusted and reliability-adjusted rates of video-assisted thoracoscopic surgery (VATS) lobectomy by hospital quintile of VATS rates. (B) The percentage of hospitals with available VATS technology within each quintile as indicated by having performed a VATS wedge in the same study period. The adjustment models accounted for age, sex, race, Charlson-Deyo Comorbidity Index score, patient insurance status, tumor histology and clinical T and N stage, regional median income quartile, education, and clustering within hospitals. The Annals of Thoracic Surgery 2017 103, 454-460DOI: (10.1016/j.athoracsur.2016.08.091) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Regional variation in risk-adjusted and reliability-adjusted rates of video-assisted thoracoscopic surgery (VATS) lobectomy. The National Cancer Data Base divides the United States into 9 contiguous geographic regions. Adjusted VATS lobectomy rates were highest in the Middle Atlantic region (NJ, NY, PA) and lowest in the West South Central region (AR, LA, OK, TX). The Annals of Thoracic Surgery 2017 103, 454-460DOI: (10.1016/j.athoracsur.2016.08.091) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Adjusted overall survival by hospital video-assisted thoracoscopic surgery (VATS) lobectomy adoption quintile. Hospitals in the highest VATS quintile had slightly better hospital-level survival estimates than those in the lowest quintile (p = 0.033), although the differences are clinically minute. The Annals of Thoracic Surgery 2017 103, 454-460DOI: (10.1016/j.athoracsur.2016.08.091) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions