From the register of the Society of Cardiothoracic Surgeons of Great Britain and Ireland (2000-2002) we extracted for the counts of patients operated on for pneumothorax, lobectomy, and sublobar (usually wedge) resections. Multilevel logistic regression was used to take account of the clustering of patients within centres (MlwiN statistical package, release 1.10.0007). We transformed the proportions of VATS versus thoracotomy for each hospital on to log odds scales and used the variance among hospitals as a measure of the variation in VATS use. We estimated the correlation between VATS use for pneumothorax and minor resection with the multilevel approach.
Pneumothorax surgery—2606 procedures were performed in 40 centres. VATS was used in 1485 (57%) of these procedures. VATS use ranged from 0% to 100% ().
Variation between UK hospitals in use of VATS for pneumothorax. Centres are ranked by proportion of VATS use and vertical lines represent 95% confidence intervals
Minor resection—2691 procedures were performed in 39 centres. VATS was used in 1507 (56%), with less variation compared with pneumothorax surgery.
Lobectomy—3879 lobectomies were performed in 40 hospitals. VATS was used in only six hospitals, with two hospitals accounting for over 60% of the use. As only 3% (n = 123) of lobectomies were performed by VATS in just 15% of units, further statistical analysis was not considered useful.
Variation between hospitals in VATS use for pneumothorax surgery was substantially larger than that for minor resection (variance in use on log odds scale 5.0 and 1.1, respectively, P < 0.001). The correlation between use of VATS for pneumothorax surgery and minor resections was estimated to be 0.39 (P = 0.04). Variation was not related to the total number of procedures that the units had carried out.
What is already known on this topic
Video assisted thoracic surgery is effective and is a less invasive treatment for pneumothorax than thoracotomy
What this study adds
In the United Kingdom adoption of video assisted thoracic surgery for pneumothorax ranges from none to 100%