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Surgeon specialty and operative mortality with lung resection
Philip P Goodney1, F L Lucas, Therese A Stukel
1VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA. philip.goodney@hitchcock.org
Annals of Surgery
|December 29, 2004
Summary
Lung resection operative mortality is lower for cardiothoracic and noncardiac thoracic surgeons compared to general surgeons. Subspecialty training and high-volume centers significantly impact lung cancer surgery outcomes.
Area of Science:
- Thoracic Surgery
- Surgical Outcomes Research
- Health Services Research
Background:
- Lung resection for cancer is performed by various surgical subspecialists.
- There is a prevailing belief that board-certified thoracic surgeons are best suited for lung resection procedures.
Purpose of the Study:
- To investigate the impact of surgical subspecialty training on operative mortality rates after lung resection.
- To compare the outcomes of lung resections performed by general surgeons, cardiothoracic surgeons, and noncardiac thoracic surgeons.
Main Methods:
- Analysis of the national Medicare database (1998-1999) for patients undergoing lung resection for cancer.
- Surgeon subspecialty was determined using the American Board of Thoracic Surgery database and practice pattern data.
- Logistic regression models were used to compare operative mortality, adjusting for patient, surgeon, and hospital factors.
Main Results:
- Operative mortality rates were significantly lower for cardiothoracic (5.6%) and noncardiac thoracic surgeons (5.8%) compared to general surgeons (7.6%).
- In high-volume settings (surgeons or hospitals), noncardiac thoracic surgeons demonstrated the lowest mortality rates.
- Patient characteristics did not substantially vary across different surgeon specialties.
Conclusions:
- Surgeon specialty is a significant factor influencing operative mortality in lung resection.
- Both surgeon and hospital volume partially explain the variation in operative mortality observed across different surgical specialties.