surgeon specialty and operative mortality with lung resection l.
Download
Skip this Video
Download Presentation
Surgeon Specialty and Operative Mortality With Lung Resection

Loading in 2 Seconds...

play fullscreen
1 / 26

Surgeon Specialty and Operative Mortality With Lung Resection - PowerPoint PPT Presentation


  • 137 Views
  • Uploaded on

Surgeon Specialty and Operative Mortality With Lung Resection. PP Goodney, FL Lucas, TS Stukel, JD Birkmeyer VA Outcomes Group, White River Junction, VT Dartmouth-Hitchcock Medical Center, Lebanon, NH. Background.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Surgeon Specialty and Operative Mortality With Lung Resection' - MikeCarlo


Download Now An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
surgeon specialty and operative mortality with lung resection

Surgeon Specialty and Operative Mortality With Lung Resection

PP Goodney, FL Lucas, TS Stukel, JD Birkmeyer

VA Outcomes Group, White River Junction, VT

Dartmouth-Hitchcock Medical Center, Lebanon, NH

background
Background
  • Several studies have reported variation in outcomes according to surgeon specialty
    • colorectal resection for cancer
      • Wigmore et al, Ann Surg1999
    • carotid endarterectomy
      • Hannan et al, Stroke2001
  • Not all studies have confirmed this finding
      • Cowan et al, JACS2002
lung resection
Lung resection
  • Resection for lung cancer
    • approximately 25,000 cases per year in the U.S.
    • Performed by:
      • General surgeons
      • Cardiothoracic surgeons
      • Non-cardiac thoracic surgeons

www.seer.cancer.gov

research question
Research question

Does surgeon specialty affect operative mortality in lung resection for lung cancer?

subjects and databases
Subjects and databases
  • Study population
    • All Medicare beneficiaries 1998-1999
    • Age 65-99
  • Patient selection
    • Procedure code for lung resection
      • (pneumonectomy or lobectomy)
    • Diagnosis code for lung cancer
    • Unique physician identifier number (UPIN) present on discharge abstract
slide6

Surgeon

Specialty Assignment

slide7

Surgeon

Specialty Assignment

American Board of

Thoracic Surgery

member?

slide8

Surgeon

Specialty Assignment

American Board of

Thoracic Surgery

member?

Perform

CABG?

slide9

Surgeon

Specialty Assignment

American Board of

Thoracic Surgery

member?

Perform

CABG?

analysis
Analysis
  • Unit of analysis: patient
  • Main exposure: surgeon specialty
    • General, cardiothoracic, non-cardiac thoracic
  • Main outcome measure: operative mortality
    • Combination of death before discharge or within thirty days of the index procedure
analysis11
Analysis
  • Using multiple logistic regression models, adjusted for the following:

Patient variables:

Age, sex, race

Comorbidity score

Admission acuity

Extent of resection

Hospital variables:

Hospital volume

Bed size

Teaching status

Medical school affiliation

ACS-approved cancer center

Surgeon variables:

Surgeon volume

Clustering

adjusted operative mortality by surgeon subspecialty
Adjusted operative mortality, by surgeon subspecialty

Cardiothoracic

Non-cardiac thoracic

General

p <0.001 between all groups

adjusted operative mortality by extent of resection
Adjusted operative mortality, by extent of resection

Cardio.

Cardiothoracic

General

NCTS

General

NCTS

p <0.001 between all groups

adjusted operative mortality with high volume surgeons
Adjusted operative mortality, with high-volume surgeons

Cardiothoracic

Non-cardiac thoracic

General

p <0.01 between non-cardiac thoracic surgeons and others

adjusted operative mortality in high volume hospitals
Adjusted operative mortality, in high-volume hospitals

Cardiothoracic

Non-cardiac thoracic

General

p <0.01 between non-cardiac thoracic surgeons and others

summary
Summary
  • Operative mortality with lung resection varies by surgeon specialty
  • Risks were lowest for non-cardiac thoracic surgeons
  • Hospital and surgeon volume account for some, but not all of this effect
limitations
Limitations
  • Administrative data for risk adjustment
  • Error in assignment of surgeon specialty
    • Bias would tend towards the null
why does performance differ across specialty
Why does performance differ across specialty?
  • Additional training
  • Structural differences across specialty
    • Larger hospitals
    • Medical school affiliations
    • ACS-approved cancer programs
  • Another possibility –
    • Differences in processes of care
      • Intensivist-managed ICUs, epidural catheters, pulmonary protocols
      • Many of these processes are unmeasured in current quality improvement initiatives such as the STS database
do our findings matter
Do our findings matter?
  • Although these differences are statistically significant, are they clinically important?
  • Differences are small (~1%) for lobectomy, but larger (~5%) for pneumonectomy
  • How much is enough?
    • Only patients can decide
conclusion
Conclusion
  • Surgeon specialty impacts operative mortality with lung resection
  • Some, but not all of this difference can be explained by volume
  • Further study of these differences may hold potential for improvement
acknowledgement
Acknowledgement
  • Scottie Siewers
  • VA Outcomes Group