James M Clark1, Angelica S Marrufo1, Benjamin D Kozower2, Daniel J Tancredi3, Miriam Nuño4, David T Cooke5, Brad H Pollock6, Patrick S Romano7, Lisa M Brown8. 1. Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento, California. 2. Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St Louis, Missouri. 3. Center for Healthcare Policy and Research, University of California, Davis Health, Sacramento, California. 4. Department of Public Health Sciences, University of California, Davis Health, Sacramento, California; Outcomes Research Group, Department of Surgery, University of California, Davis Health, Sacramento, California. 5. Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento, California; Outcomes Research Group, Department of Surgery, University of California, Davis Health, Sacramento, California. 6. Department of Public Health Sciences, University of California, Davis Health, Sacramento, California. 7. Center for Healthcare Policy and Research, University of California, Davis Health, Sacramento, California; Outcomes Research Group, Department of Surgery, University of California, Davis Health, Sacramento, California; Department of Internal Medicine, University of California, Davis Health, Sacramento, California. 8. Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento, California; Outcomes Research Group, Department of Surgery, University of California, Davis Health, Sacramento, California. Electronic address: lmbrown@ucdavis.edu.
Abstract
BACKGROUND: Cardiopulmonary assessment for lung resection is important for risk stratification, and the American College of Chest Physicians (ACCP) guidelines provide decision support. We ascertained the cardiopulmonary assessment practices of thoracic surgeons and determined whether they are guideline concordant. METHODS: An anonymous survey was emailed to 846 thoracic surgeons who participate in The Society of Thoracic Surgeons General Thoracic Surgery Database. We analyzed survey responses by practice type (general thoracic [GT] versus cardiothoracic [CT]) and years in practice (0-9, 10-19, and ≥20) with the use of contingency tables. We compared adherence of survey responses with the guidelines. RESULTS: The response rate was 24.0% (n = 203). Most surgeons (n = 121, 59.6%) cited a predicted postoperative forced expiratory volume in 1 second or diffusing capacity of lung for carbon monoxide threshold of 40% for further evaluation. Experienced surgeons (≥20 years) were more likely to have a threshold that varies by surgical approach (31.3% versus 23.5% with 10-19 years of experience and 15.9% for 0-9 years of experience, P = .007). Overall, 52.2% refer patients with cardiovascular risk factors to cardiology and 42.9% refer patients with abnormal stress testing. CT surgeons were more likely to refer all patients to cardiology than GT surgeons (17.6% versus 2.4%, P < .001). Only one respondent (0.5%) was 100% adherent to the ACCP guidelines, and 4.4% and 45.8% were 75% and 50% adherent, respectively. CONCLUSIONS: Among thoracic surgeons, there is variation in preoperative cardiopulmonary assessment practices, with differences by practice type and years in practice, and marked discordance with the ACCP guidelines. Further study of guideline adherence linked to postoperative morbidity and mortality is warranted to determine whether adherence affects outcomes.
BACKGROUND: Cardiopulmonary assessment for lung resection is important for risk stratification, and the American College of Chest Physicians (ACCP) guidelines provide decision support. We ascertained the cardiopulmonary assessment practices of thoracic surgeons and determined whether they are guideline concordant. METHODS: An anonymous survey was emailed to 846 thoracic surgeons who participate in The Society of Thoracic Surgeons General Thoracic Surgery Database. We analyzed survey responses by practice type (general thoracic [GT] versus cardiothoracic [CT]) and years in practice (0-9, 10-19, and ≥20) with the use of contingency tables. We compared adherence of survey responses with the guidelines. RESULTS: The response rate was 24.0% (n = 203). Most surgeons (n = 121, 59.6%) cited a predicted postoperative forced expiratory volume in 1 second or diffusing capacity of lung for carbon monoxide threshold of 40% for further evaluation. Experienced surgeons (≥20 years) were more likely to have a threshold that varies by surgical approach (31.3% versus 23.5% with 10-19 years of experience and 15.9% for 0-9 years of experience, P = .007). Overall, 52.2% refer patients with cardiovascular risk factors to cardiology and 42.9% refer patients with abnormal stress testing. CT surgeons were more likely to refer all patients to cardiology than GT surgeons (17.6% versus 2.4%, P < .001). Only one respondent (0.5%) was 100% adherent to the ACCP guidelines, and 4.4% and 45.8% were 75% and 50% adherent, respectively. CONCLUSIONS: Among thoracic surgeons, there is variation in preoperative cardiopulmonary assessment practices, with differences by practice type and years in practice, and marked discordance with the ACCP guidelines. Further study of guideline adherence linked to postoperative morbidity and mortality is warranted to determine whether adherence affects outcomes.
Authors: Mohammad R Ghamati; Wilson W L Li; Erik H F M van der Heijden; Ad F T M Verhagen; Ronald A Damhuis Journal: J Thorac Dis Date: 2021-10 Impact factor: 3.005
Authors: Anne C Melzer; Abbie Begnaud; Bruce R Lindgren; Kelsey Schertz; Steven S Fu; David M Vock; Alexander J Rothman; Anne M Joseph Journal: Cancer Treat Res Commun Date: 2021-07-31