BACKGROUND: Long-term outcomes and processes of care in patients undergoing pulmonary resection for lung cancer may vary by surgeon type. Associations between surgeon specialty and processes of care and long-term survival have not been described. METHODS: A cohort study (1992 through 2002, follow-up through 2005) was conducted using Surveillance, Epidemiology, and End-Results-Medicare data. The American Board of Thoracic Surgery Diplomates list was used to differentiate board-certified thoracic surgeons from general surgeons (GS). Board-certified thoracic surgeons were designated as cardiothoracic surgeons (CTS) if they performed cardiac procedures and as general thoracic surgeons (GTS) if they did not. RESULTS: Among 19,745 patients, 32% were cared for by GTS, 45% by CTS, and 24% by GS. Patient age, comorbidity index, and resection type did not vary by surgeon specialty (all p > 0.10). Compared with GS and CTS, GTS more frequently used positron emission tomography (36% versus 26% versus 26%, respectively; p = 0.005) and lymphadenectomy (33% versus 22% versus 11%, respectively; p < 0.001). After adjustment for patient, disease, and management characteristics, hospital teaching status, and surgeon and hospital volume, patients treated by GTS had an 11% lower hazard of death compared with those who underwent resection by GS (hazard ratio, 0.89; 99% confidence interval, 0.82 to 0.97). The risks of death did not vary significantly between CTS and GS (hazard ratio, 0.94; 99% confidence interval, 0.88 to 1.01) or GTS and CTS (hazard ratio, 0.94; 99% confidence interval, 0.87 to 1.03). CONCLUSIONS: Lung cancer patients treated by GTS had higher long-term survival rates than those treated by GS. General thoracic surgeons performed preoperative and intraoperative staging more often than GS or CTS.
BACKGROUND: Long-term outcomes and processes of care in patients undergoing pulmonary resection for lung cancer may vary by surgeon type. Associations between surgeon specialty and processes of care and long-term survival have not been described. METHODS: A cohort study (1992 through 2002, follow-up through 2005) was conducted using Surveillance, Epidemiology, and End-Results-Medicare data. The American Board of Thoracic Surgery Diplomates list was used to differentiate board-certified thoracic surgeons from general surgeons (GS). Board-certified thoracic surgeons were designated as cardiothoracic surgeons (CTS) if they performed cardiac procedures and as general thoracic surgeons (GTS) if they did not. RESULTS: Among 19,745 patients, 32% were cared for by GTS, 45% by CTS, and 24% by GS. Patient age, comorbidity index, and resection type did not vary by surgeon specialty (all p > 0.10). Compared with GS and CTS, GTS more frequently used positron emission tomography (36% versus 26% versus 26%, respectively; p = 0.005) and lymphadenectomy (33% versus 22% versus 11%, respectively; p < 0.001). After adjustment for patient, disease, and management characteristics, hospital teaching status, and surgeon and hospital volume, patients treated by GTS had an 11% lower hazard of death compared with those who underwent resection by GS (hazard ratio, 0.89; 99% confidence interval, 0.82 to 0.97). The risks of death did not vary significantly between CTS and GS (hazard ratio, 0.94; 99% confidence interval, 0.88 to 1.01) or GTS and CTS (hazard ratio, 0.94; 99% confidence interval, 0.87 to 1.03). CONCLUSIONS:Lung cancerpatients treated by GTS had higher long-term survival rates than those treated by GS. General thoracic surgeons performed preoperative and intraoperative staging more often than GS or CTS.
Authors: Nader N Massarweh; James O Park; Farhood Farjah; Raymond S W Yeung; Rebecca Gaston Symons; Thomas L Vaughan; Laura-Mae Baldwin; David R Flum Journal: J Am Coll Surg Date: 2010-04 Impact factor: 6.113
Authors: Rob G Stirling; S M Evans; P McLaughlin; M Senthuren; J Millar; J Gooi; L Irving; P Mitchell; A Haydon; J Ruben; M Conron; T Leong; N Watkins; J J McNeil Journal: Lung Date: 2014-06-08 Impact factor: 2.584
Authors: Nicole Ezer; Minal Kale; Keith Sigel; Sameer Lakha; Grace Mhango; Emily Goodman; Daniel Nicastri; Scott Swanson; Alfred Neugut; Juan P Wisnivesky Journal: Ann Am Thorac Soc Date: 2018-01
Authors: Onkar V Khullar; Theresa Gillespie; Dana C Nickleach; Yuan Liu; Kristin Higgins; Suresh Ramalingam; Joseph Lipscomb; Felix G Fernandez Journal: J Am Coll Surg Date: 2014-10-27 Impact factor: 6.113