PURPOSE: The quality literature has a recurrent theme regarding sub-specialization or surgical cases. The thoracic literature does not have a great deal of literature comparing general surgeons to thoracic surgeons on thoracic procedures. The National surgical quality improvement project (NSQIP) offers the opportunity to stratify outcomes in thoracic procedures by specialty type and acuity adjust based on patient co-morbidities. We hypothesized that thoracic surgeons would obtain superior outcomes when viewed in an acuity adjusted manner.
METHODS: Under the data use agreement of the American College of Surgeons and with the approval of our institutional review board, we obtained five years of NSQIP data. We selected the procedures based on Current procedural terminology to be lung and pleural based. Outcomes were further stratified based on Clavien Classification focusing on class 4 and death, as well as categories of adverse outcome: any occurence, any infection, wound related event, clavien 4 and death. We analyzed outcomes in a univariate and multi-variate modalities in SPSS 19 (IBM, NY).
RESULTS: When selecting for CPT based ranges 6373 patients were identified for further analysis. 2993 (47%) were performed by thoracic surgeons. The thoracic surgeons operated on slightly older patients (mean age 61.3 vs 59.46) billed slightly more Relative Value Units on average (19.72 vs 18.97), and patients stayed less time (8.1 days vs 9.1) (P-value <.001). They were less likely to operate emergently (4% vs 7.7%) but their patients had higher ASA scores, with less than 20% having ASA 1 or 2 (vs 28.6% for general surgeons). Univariate analysis with chi-square demonstrated significant differences: infection OR 1.3 p=.001, any occurrence OR 1.2 p=.002, Clavien 4 complication or death OR 1.29, p=.003, death OR 1.29, p=.035.
CONCLUSIONS: This data is limited by its retrospective observational nature. It does not contain indications, or traditional acuity adjustors such as pulmonary function. Yet the data is compelling and consistent with other work looking at procedural outcomes in technically challenging procedures. Perhaps the general surgeon is no longer able to match outcomes with their sub-specialized colleagues. Further work is warranted.
CLINICAL IMPLICATIONS: To assess whether thoracic procedures have better outcomes when performed by thoracic surgeons.
DISCLOSURE: The following authors have nothing to disclose: Arielle Hodari, Athanasios Tsiouris, Michael Eichenhorn, Gaetano Paone, Ilan Rubinfeld
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