The influence of surgeon specialty on outcomes in general thoracic surgery: a national sample 1996 to 2005.
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.
Schipper
Paul H
PH
Division of Cardiothoracic Surgery, Oregon Health and Science University, Portland, Oregon 97239-3011, USA. schippep@ohsu.edu
Diggs
Brian S
BS
Ungerleider
Ross M
RM
Welke
Karl F
KF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D013502:General Surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011013:Pneumonectomy / Q000592:standards*; D012189:Retrospective Studies; D013043:Specialties, Surgical; D013903:Thoracic Surgery; D014481:United States; D055815:Young Adult