HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Mark B. Orringer Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Dimick, J. B. Articles by Birkmeyer, J. D. Search for Related Content PubMed PubMed Citation Articles by Dimick, J. B. Articles by Birkmeyer, J. D. Related Collections Esophagus - cancer

Ann Thorac Surg 2005;80:282-286
© 2005 The Society of Thoracic Surgeons

---

Original article: General thoracic

Specialty Training and Mortality After Esophageal Cancer Resection

^a VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont
^b Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, New Hampshire
^c Michigan Surgical Collaborative for Outcomes Research and Evaluation (M-SCORE), Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan

Accepted for publication January 17, 2005.

^_* Address reprint requests to Dr Dimick, VA Outcomes Group 111B, VA Medical Center, 215 N Main St, White River Junction, VT05009 (Email: justin.b.dimick{at}dartmouth.edu).

BACKGROUND: Surgeons with advanced training have lower mortality rates with some surgical procedures. The objective of the current study was to investigate the impact of thoracic surgery training on mortality rates of esophageal cancer resection.

METHODS: We studied esophageal cancer resection in the national Medicare population during 1998 and 1999. Operative mortality rates (in-hospital or 30-day) were compared for thoracic surgeons and other surgeons, adjusting for patient characteristics, hospital volume, and surgeon volume. Surgeons with specialty training in thoracic surgery were those certified by the American Board of Thoracic Surgery.

RESULTS: Of the 1,946 patients, 625 (32%) had their operation performed by a thoracic surgeon. After adjustment for patient characteristics, mortality rates were 37% (odds ratio, 1.37; 95% confidence interval, 1.02 to 1.82) higher for surgeons without specialty training compared with thoracic surgeons (adjusted mortality 16.5% versus 12.4%; p = 0.01). However, differences in mortality between high-volume and low-volume hospitals (24.3% versus 11.4%; p < 0.001) and surgeons (20.7% versus 10.7%; p < 0.001) were larger than those between thoracic and general surgeons. Although thoracic surgeons had lower mortality rates after adjusting for hospital volume, the effect of thoracic surgery training was no longer significant after accounting for surgeon volume (odds ratio, 1.23; 95% confidence interval, 0.92 to 1.63).

CONCLUSIONS: Specialty training in thoracic surgery has an independent association with lower mortality after esophageal resection. But specialty training appears to be less important than hospital and surgeon volume.

This article has been cited by other articles:

				J. Ra, E. C. Paulson, J. Kucharczuk, K. Armstrong, C. Wirtalla, R. Rapaport-Kelz, L. R. Kaiser, and F. R. Spitz Postoperative Mortality After Esophagectomy for Cancer: Development of a Preoperative Risk Prediction Model Ann. Surg. Oncol., June 1, 2008; 15(6): 1577 - 1584. [Abstract] [Full Text] [PDF]

				A. Pennathur and J. D. Luketich Resection for Esophageal Cancer: Strategies for Optimal Management Ann. Thorac. Surg., February 1, 2008; 85(2): S751 - S756. [Abstract] [Full Text] [PDF]