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Original Articles: General Thoracic

The Influence of Surgeon Specialty on Outcomes in General Thoracic Surgery: A National Sample 1996 to 2005

^a Division of Cardiothoracic Surgery, Oregon Health and Science University, Portland, Oregon
^b Department of Surgery, Oregon Health and Science University, Portland, Oregon

Accepted for publication August 21, 2009.

^_* Address correspondence to Dr Schipper, Division of Cardiothoracic Surgery L353, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3011 (Email: schippep{at}ohsu.edu).

Presented at the Fifty-fifth Annual Meeting of the Southern Thoracic Surgical Association, Austin, TX, Nov 5–8, 2008.

Background: While general thoracic surgical procedures are performed by several different surgical subspecialties, debate remains as to whether surgeon specialty impacts outcomes.

Methods: The Nationwide Inpatient Sample (NIS) was queried for procedure codes for pneumonectomy, lobectomy, limited lung resection, and decortication. We constructed multivariate logistic regression models to calculate odds of hospital mortality or length-of-stay (LOS) greater than 14 days (a marker of morbidity), adjusted for age, sex, patient comorbidities, hospital setting, and surgeon specialty. A surgeon was considered general thoracic if they performed greater than 75% general thoracic operations and less than 10% cardiac operations, Cardiac if greater than 10% cardiac operations, and general surgeon if less than 75% general thoracic and less than 10% cardiac operations. A second set of models additionally adjusted for procedure-specific hospital and surgeon volume.

Results: From 1996 to 2005, the NIS estimates 41,808 pneumonectomies, 321,767 lobectomies, 75,200 limited lung resections, and 149,318 decortications were performed in the United States. For all procedures studied, general thoracic surgeons had significantly decreased odds-of-death and LOS greater than 14 days compared with general surgeons. Cardiac surgeons had significantly decreased LOS greater than 14 days for all operations and decreased odds-of-death for decortications, lobectomy, and limited lung resection compared with general surgeons. When further adjusted for surgeon volume, most differences in odds-of-death were no longer present; however, significantly decreased LOS greater than 14 days largely persisted for both general thoracic and cardiac surgeons.

Conclusions: The majority of general thoracic surgical operations in the United States are performed by surgeons not specializing in thoracic surgery. Both general thoracic surgeons and cardiac surgeons achieve better outcomes than general surgeons. Differences in mortality may be more dependent on surgeon volume than subspecialty. Differences in morbidity are significantly impacted by surgeon specialty and volume.

Related Article

Surgeon Specialty Is Associated With Better Outcomes: The Facts Speak for Themselves

Douglas E. Wood and Farhood Farjah
Ann. Thorac. Surg. 2009 88: 1393-1395. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				D. E. Wood and F. Farjah Surgeon specialty is associated with better outcomes: the facts speak for themselves. Ann. Thorac. Surg., November 1, 2009; 88(5): 1393 - 1395. [Full Text] [PDF]