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

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 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 30day 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.