Do individual surgeon volumes affect outcomes in thoracic surgery?†

Area of Science:

• Thoracic Surgery
• Health Services Research
• Surgical Outcomes

Background:

• Minimum volume standards for thoracic procedures are debated due to methodology concerns.
• Existing research primarily focuses on hospital volume, with limited data on individual surgeon volume.
• This study investigates the association between surgeon volume and patient outcomes in major lung resections.

Purpose of the Study:

• To determine if individual thoracic surgeon volume is associated with differences in patient outcomes.
• To analyze outcomes based on surgeon volume tertiles for sublobar resection, lobectomy, and pneumonectomy.
• To assess the impact of surgeon volume on in-hospital mortality and 30-day readmission rates.

Main Methods:

• Utilized New York State SPARCS data from 1995-2014 for major lung resections.
• Categorized patients into subgroups based on resection extent (sublobar, lobectomy, pneumonectomy).
• Calculated average annual surgeon volumes and grouped surgeons into tertiles (low, intermediate, high) to analyze outcomes and complications.

Main Results:

• 99,576 major lung resections were analyzed.
• Low-volume surgeons demonstrated significantly higher in-hospital mortality across all resection types.
• Higher 30-day readmission rates were observed for low-volume surgeons in lobectomy and pneumonectomy cases.
• Low-volume surgeons disproportionately operated on Black patients and those with Medicaid, with Black race being an independent predictor of mortality.

Conclusions:

• Thoracic surgeons with lower annual case volumes exhibit higher in-hospital mortality rates compared to high-volume surgeons.
• The majority of lobectomy surgeons (89.5%) fall into the low-volume category.
• Implementing minimum volume standards could significantly alter current thoracic surgery practice in the US, particularly given demographic disparities observed.