title: Pulmonary resections performed at hospitals with thoracic surgery residency programs have superior outcomes.
abstract: OBJECTIVE
  Pulmonary resections are performed at thoracic residency (TR), general surgery residency (GSR), no surgery residency, and no residency hospitals. We hypothesize that morbidity and mortality for these procedures are different between hospitals and that operations performed at TR teaching hospitals have superior results.
  
  
  METHODS
  Records of adults who underwent pneumonectomy, lobar, segmentectomy, and nonanatomic wedge resections (N = 498,099) were evaluated in an all-payer inpatient database between 2003 and 2009. Hospital teaching status was determined by linkage to Association of American Medical College's Graduate Medical Education Tracking System. Multiple hierarchical regression models examined the in-hospital mortality, occurrence of any complication, and failure to rescue.
  
  
  RESULTS
  The mean annual pulmonary resection volume among hospitals was TR (16%), GSR (17%), no surgery residency (28%), and no residency (39%). Unadjusted mortality for all procedures was lowest at TR hospitals (P < .001). Likewise, any complication was least likely to occur at TR hospitals (P < .001). After case-mix adjustment, the risk of any complication after segmentectomy or nonanatomic wedge resection was lower at TR hospitals than in GSR hospitals (P < .001). Among pneumonectomy recipients, TR hospitals reduced the adjusted odds ratio of failure to rescue by more than 25% compared with no surgery residency (P < .001). Likewise, in patients who underwent pneumonectomy, TR centers were associated with reducing the odds ratio of death by more than 30% compared with GSR hospitals (P < .001).
  
  
  CONCLUSIONS
  In comparison with other hospitals, including GSR hospitals, TR hospitals have lower morbidity and mortality. These results support using hospitals with a TR as an independent prognostic indicator of outcomes in pulmonary resections.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA 22908-0679, USA.
authors.forename: Castigliano M
authors.initials: CM
authors.lastname: Bhamidipati
authors.forename: George J
authors.initials: GJ
authors.lastname: Stukenborg
authors.forename: Gorav
authors.initials: G
authors.lastname: Ailawadi
authors.forename: Christine L
authors.initials: CL
authors.lastname: Lau
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Kozower
authors.forename: David R
authors.initials: DR
authors.lastname: Jones
mesh_terms: D004503:Education, Medical, Graduate / Q000706:statistics & numerical data; D017052:Hospital Mortality; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data; D016017:Odds Ratio; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D019984:Quality Indicators, Health Care; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D013903:Thoracic Surgery / Q000193:education* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States