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Patients with linked Hospital Episode Statistics records were included and those undergoing lung resection comprised the surgical cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Annual resection rates, procedure type, operative approach, centre-level variation in segmentectomy use and robotic-assisted thoracoscopic surgery (RATS) adoption, 90-day mortality, 30-day emergency readmission and postoperative length of stay. Multivariable regression models adjusted for patient and clinical case mix.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 308\u2009117 patients with NSCLC, 54\u2009138 (17.6%) underwent lung resection. The resection rate increased from 15.4% in 2015 to 20.9% in 2023, while the proportion of patients diagnosed with stage I disease increased from 17.4% to 26.8%. Segmentectomy use increased from 11.2% to 20.6%, pneumonectomy declined fourfold and minimally invasive surgery increased from 47.1% to 79.7%. In 2023, centre-level variation was marked in segmentectomy for small stage IA tumours (risk-adjusted range 10.7%\u201380.3%) and RATS use (range 0%\u201367%). 90-day mortality decreased from 4.03% to 2.26%, length of stay shortened and readmission remained stable at approximately 10%\u201312%. Each successive year of diagnosis was associated with lower 90-day mortality after adjustment for case mix (adjusted OR 0.95, 95%\u2009CI 0.93 to 0.98).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Between 2015 and 2023, surgical management of NSCLC in England changed substantially, with increased resection rates, greater use of segmentectomy and minimally invasive approaches and improved short-term postoperative outcomes. However, persistent variation in segmentectomy use and robotic adoption suggests that implementation of contemporary surgical practice remains heterogeneous across centres.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-121905","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T14:55:20Z","timestamp":1789570520000},"page":"e121905","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["National trends, variation and short-term outcomes in surgery for non-small cell lung cancer in England, 2015\u20132023: a population-based cohort study using linked national cancer registration and hospital administrative data"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5573-7080","authenticated-orcid":false,"given":"Lauren Kari","family":"Dixon","sequence":"first","affiliation":[{"name":"Clinical Effectiveness Unit, Royal College of Surgeons, London, UK"},{"name":"Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Cook","sequence":"additional","affiliation":[{"name":"Clinical Effectiveness Unit, Royal College of Surgeons, London, UK"},{"name":"Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Cook","sequence":"additional","affiliation":[{"name":"Royal College of Surgeons, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Thomas","sequence":"additional","affiliation":[{"name":"Clinical Effectiveness Unit, Royal College of Surgeons, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Boudour","sequence":"additional","affiliation":[{"name":"Royal College of Surgeons, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faine","family":"Chan","sequence":"additional","affiliation":[{"name":"Clinical Effectiveness Unit, Royal College of Surgeons, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Conibear","sequence":"additional","affiliation":[{"name":"St Bartholomew\u2019s Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"West","sequence":"additional","affiliation":[{"name":"University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neal","family":"Navani","sequence":"additional","affiliation":[{"name":"University College London, London, UK"},{"name":"Lungs for Living Research Centre, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A","family":"Cromwell","sequence":"additional","affiliation":[{"name":"Clinical Effectiveness Unit, Royal College of Surgeons, London, UK"},{"name":"Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"2026091607550832000_16.9.e121905.1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"2026091607550832000_16.9.e121905.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2024.05.026"},{"key":"2026091607550832000_16.9.e121905.3","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2011.158972"},{"key":"2026091607550832000_16.9.e121905.4","unstructured":"NHS England . 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