Introduction Surgical resection rates have become an important indicator of NHS Trust performance and efforts to increase them are on-going with the aim of improving overall survival. The National Lung Cancer Audit (NLCA) has collected data on primary lung cancer since 2004 and has now been linked with Hospital Episode Statistics (HES) for research into inequalities in access to treatment. How well these two large datasets capture surgical data is not known.
Methods We used the NLCA to identify all cases of NSCLC, excluding stage IIIB or IV, diagnosed between January 2004 and March 2010. We calculated the proportion of cases with a procedure date in the NLCA, and the proportion with a code in HES, for potentially curative surgery less than 6 months after or 3 months before diagnosis. We looked at the age, lung function, performance status, stage and survival according to where surgery was recorded. Given the increase in NLCA case ascertainment from approximately 19% in 2004 to 98% in 2009 we also looked for changes in our results over time.
Results There were 60,196 people in the NLCA who met the inclusion criteria; 8,535 (14%) had a record of surgery in both databases. An additional 2,568 (4%) had a record of surgery in HES and 795 (1%) in the NLCA. The features of people who had surgery in HES only or the NLCA only were similar, however median survival was shorter, and the proportion that died soon after surgery was higher, in the NLCA only group compared with those with surgery records in both databases (table 1). The proportion with HES only records of surgery decreased from 6% (n = 215) in 2004 to 3% (n = 367) in 2009; the patterns of survival each year were similar to the overall results.
Conclusion The proportion of people who had potentially curative surgery differed according to the database used to identify surgical procedures. There are many possible explanations for our results; however use of either database alone is likely to under-estimate the proportion of people who had surgery and this should be taken into account in studies investigating access to surgery.
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