An American College of Surgeons National Quality Improvement Collaborative to Enhance Lung Cancer Surgical Quality

Importance: Sampling of at least 3 mediastinal and at least 1 hilar nodal stations during lung cancer resection was adopted by the American College of Surgeons (ACS) Commission on Cancer (CoC) as Operative Standard 5.8 to ensure appropriate staging, guide adjuvant systemic therapy, and potentially improve overall survival. Early assessments suggested difficulty with reaching goal hospital-level compliance rates of at least 80%. Objective: The objective of this study was to compare compliance with Standard 5.8 before and after participation in the Lung NODES National Quality Improvement (QI) Collaborative. Design, Setting, and Participants: This quality improvement study reports findings from a prospective national QI collaborative led by the ACS CoC, Lung NODES, which enrolled CoC-accredited programs across the US from March 2024 to December 2024. Programs actively participated in guided root cause analyses, educational webinars, peer-to-peer learning, and the development and implementation of strategies to increase compliance. Data were collected on patients aged 18 years or older undergoing curative intent lung resection. Main Outcomes and Measures: Adjusted multilevel logistic regression models, with hospital as a random effect, investigated variables associated with compliance with Standard 5.8. Differences in hospital-level compliance, at baseline compared to final data collection, were assessed using Wilcoxon signed rank tests. Results: Among 354 participating programs, the number of programs achieving at least 80% compliance with Standard 5.8 increased from 144 (40.7%) at baseline to 238 (67.2%) after participation. Hospital-level median compliance increased from 67.8% (IQR, 42.9%-90.0%) to 90.5% (IQR, 70.0%-100%) (P < .001). All hospital types had an increase in median compliance, with the largest absolute increase, of 37.1%, seen for community programs. On adjusted multilevel analyses, compared to baseline, lung cancer resections performed after participation were associated with increased odds of compliant lymph node assessment (adjusted odds ratio, 2.50; 95% CI, 2.19-2.86). Conclusions and Relevance: Participation in the Lung NODES National QI Collaborative was associated with higher compliance with Standard 5.8 irrespective of hospital characteristics. National QI collaboratives may represent an effective large-scale approach to address gaps in the delivery of high-quality cancer care.