A comparison of quality and cost indicators by surgical specialty for lobectomy of the lung.
OBJECTIVE
This investigation compared patients undergoing lobectomy for non-small cell lung cancer by either a general surgeon or a cardiothoracic surgeon across a geographically diverse system of hospitals to see whether a significant difference in quality or cost was present.


METHODS
The Premiere administrative database and tumor registry data of a single health system's hospitals was used to compare adherence to national treatment guidelines, patient outcomes, and charges for patients undergoing lobectomy for non-small cell lung cancer in a 5-year period. Surgeons performing lobectomy were designated as a general surgeon or cardiothoracic surgeon according to their national provider number and board certification status. Excluded from analysis were centers that performed fewer than 50 lobectomies during the study period.


RESULTS
During the study period, 2823 lobectomies were performed by 46 general surgeons and 3653 lobectomies were performed by 29 cardiothoracic surgeons in 54 hospitals in a single health care system. Significant differences were found between general and cardiothoracic surgeons with respect to adherence to national guidelines in staging and treatment, mean length of stay, significant morbidity, and operative mortality. Mean charges for lobectomy of the lung were also found to differ significantly between general and cardiothoracic surgeons.


CONCLUSIONS
This review found that currently measurable indicators for quality of care were significantly superior and overall charges were significantly reduced when a lobectomy for non-small cell lung cancer was performed by a cardiothoracic surgeon rather than by a general surgeon.
Department of Thoracic and Cardiovascular Surgery, St Vincent Hospital, Indianapolis, Ind., USA. RFreeman@corvascmds.com
Richard K
RK
Freeman
J Russell
JR
Dilts
Anthony J
AJ
Ascioti
Theresa
T
Giannini
Raja J
RJ
Mahidhara
D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000601:surgery*; D004503:Education, Medical, Graduate; D005260:Female; D013502:General Surgery / Q000191:economics / Q000193:education / Q000592:standards; D019983:Guideline Adherence; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000191:economics / Q000592:standards; D011013:Pneumonectomy / Q000009:adverse effects / Q000191:economics / Q000193:education / Q000401:mortality / Q000592:standards; D011183:Postoperative Complications / Q000191:economics / Q000401:mortality / Q000628:therapy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D019984:Quality Indicators, Health Care / Q000191:economics / Q000592:standards; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013903:Thoracic Surgery / Q000191:economics / Q000193:education / Q000592:standards; D016896:Treatment Outcome; D014481:United States