Inpatient mortality and failure to rescue in lung cancer patients by hospital certification status: Cross-sectional analysis of nationwide german discharge data 2014-2023.

[INTRODUCTION] Lung cancer is the leading cause of cancer-related mortality in Germany. Certification of lung cancer centers aims to improve quality of care primarily by adhering to evidence-based guidelines and minimum case volume requirements. However, the number of procedures is also a part of nationwide requirements. This study examines the association between certification status and outcomes for lung cancer patients undergoing anatomical lung resections in Germany between 2014 and 2023 while adjusting for hospital case volume (based on lung cancer resections) and patient characteristics.

[METHODS] Nationwide Diagnosis-Related Groups data were linked with certification data from the German Cancer Society. Generalized logit regression models adjusted for age, sex, comorbidities, and hospital case volume were used to estimate in-hospital mortality and failure to rescue rates along with the corresponding 95 % confidence intervals. For each year, two separate analyses were conducted: one adjusting for patient characteristics only, and another additionally adjusting for hospital caseload.

[RESULTS] Adjusted analyses showed a trend of lower in-hospital mortality and failure to rescue rates in certified centers, both with and without adjustment for hospital case volume. However, statistical significance was observed only in the years 2020 and 2021, and only when case volume per hospital was not included as a covariate.

[CONCLUSION] While certified centers demonstrated lower in-hospital mortality and failure to rescue rates in specific years, including hospital case volume as a covariate reduced the magnitude of the differences between certified and non-certified hospitals. These results suggest that certification status and hospital case volume interact in complex ways, underscoring the need for further investigation into their independent and combined effects on patient outcomes.