title: Influence of surgical subspecialty training on in-hospital mortality for gastrectomy and colectomy patients.
abstract: OBJECTIVE
  This study examined the relationship of surgeon subspecialty training and interests to in-hospital mortality while controlling for both hospital and surgeon volume.
  
  
  BACKGROUND
  The relationship between volume of surgical procedures and in-hospital mortality has been studied and shows an inverse relationship.
  
  
  METHODS
  A large Statewide Planning and Research Cooperative System was used to identify all 55,016 inpatients who underwent gastrectomy (n = 6434) or colectomy (n = 48,582) between January 1, 1998 and December 31, 2001. Surgical subspecialty training and interest was defined as surgeons who were members of the Society of Surgical Oncology (training/interest; n = 68) or the Society of Colorectal Surgery (training; n = 61) during the study period. The association of in-hospital mortality and subspecialty training/interest was examined using a logistic regression model, adjusting for demographics, comorbidities, insurance status, and hospital and surgeon volume.
  
  
  RESULTS
  Overall mortality for colectomy patients was 4.6%; the adjusted mortality rate for subspecialty versus nonsubspecialty-trained surgeons was 2.4% versus 4.8%, respectively (adjusted odds ratio [OR] = 0.45; 95% confidence interval [CI] = 0.34, 0.60; P < 0.0001). Gastrectomy patients experienced an overall mortality rate of 8.4%; the adjusted mortality rate for patients treated by subspecialty trained surgeons was 6.5%, while the adjusted mortality rate for nonsubspecialty trained surgeons was 8.7% (adjusted OR = 0.70; 95% CI = 0.46, 1.08; P = 0.10).
  
  
  CONCLUSIONS
  For gastrectomies and colectomies, risk-adjusted mortality is substantially lower when performed by subspecialty interested and trained surgeons, even after accounting for hospital and surgeon volume and patient characteristics. These findings may have implications for surgical training programs and for regionalization of complex surgical procedures.
authors.affiliation: Department of Public Health, Weill Medical College of Cornell University and New York Presbyterian Hospital, New York, NY 10021, USA. macallah@med.cornell.edu
authors.forename: Mark A
authors.initials: MA
authors.lastname: Callahan
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Christos
authors.forename: Heather T
authors.initials: HT
authors.lastname: Gold
authors.forename: Alvin I
authors.initials: AI
authors.lastname: Mushlin
authors.forename: John M
authors.initials: JM
authors.lastname: Daly
mesh_terms: D000368:Aged; D002423:Cause of Death; D003082:Colectomy / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D005743:Gastrectomy / Q000401:mortality* / Q000706:statistics & numerical data; D013502:General Surgery / Q000193:education*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009518:New York; D016017:Odds Ratio