Goodney Philip P, Lucas F L, Stukel Therese A, Birkmeyer John D
VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA.
Ann Surg. 2005 Jan;241(1):179-84. doi: 10.1097/01.sla.0000149428.17238.03.
We sought to examine the effect of subspecialty training on operative mortality following lung resection.
While several different surgical subspecialists perform lung resection for cancer, many believe that this procedure is best performed by board-certified thoracic surgeons.
Using the national Medicare database 1998 to 1999, we identified patients undergoing lung resection (lobectomy or pneumonectomy) for lung cancer. Operating surgeons were identified by unique physician identifier codes contained in the discharge abstract. We used the American Board of Thoracic Surgery database, as well as physician practice patterns, to designate surgeons as general surgeons, cardiothoracic surgeons, or noncardiac thoracic surgeons. Using logistic regression models, we compared operative mortality across surgeon subspecialties, adjusting for patient, surgeon, and hospital characteristics.
Overall, 25,545 Medicare patients underwent lung resection, 36% by general surgeons, 39% by cardiothoracic surgeons, and 25% by noncardiac thoracic surgeons. Patient characteristics did not differ substantially by surgeon specialty. Adjusted operative mortality rates were lowest for cardiothoracic and noncardiac thoracic surgeons (7.6% general surgeons, 5.6% cardiothoracic surgeons, 5.8% noncardiac thoracic surgeons, P = 0.001). In analyses restricted to high-volume surgeons (>20 lung resections/y), mortality rates were lowest for noncardiac thoracic surgeons (5.1% noncardiac thoracic, 5.2% cardiothoracic, and 6.1% general surgeons) (P < 0.01 for difference between general surgeons and thoracic surgeons). In analyses restricted to high-volume hospitals (>45 lung resections/y), mortality rates were again lowest for noncardiac thoracic surgeons (5.0% noncardiac thoracic, 5.3% cardiothoracic, and 6.1% general surgeons) (P < 0.01 for differences between all 3 groups).
Operative mortality with lung resection varies by surgeon specialty. Some, but not all, of this variation in operative mortality is attributable to hospital and surgeon volume.
我们试图研究亚专业培训对肺切除术后手术死亡率的影响。
虽然有几种不同的外科亚专业医生进行肺癌肺切除术，但许多人认为该手术由获得委员会认证的胸外科医生来做效果最佳。
利用1998年至1999年的国家医疗保险数据库，我们确定了因肺癌接受肺切除术（肺叶切除术或全肺切除术）的患者。通过出院摘要中包含的唯一医生识别码确定手术医生。我们使用美国胸外科委员会数据库以及医生的执业模式，将外科医生分为普通外科医生、心胸外科医生或非心脏胸外科医生。使用逻辑回归模型，我们比较了不同外科亚专业的手术死亡率，并对患者、外科医生和医院特征进行了调整。
总体而言，25545名医疗保险患者接受了肺切除术，其中36%由普通外科医生实施，39%由心胸外科医生实施，25%由非心脏胸外科医生实施。患者特征在不同外科专业之间没有显著差异。心胸外科医生和非心脏胸外科医生的调整后手术死亡率最低（普通外科医生为7.6%，心胸外科医生为5.6%，非心脏胸外科医生为5.8%，P = 0.001）。在仅限于高手术量外科医生（每年>20例肺切除术）的分析中，非心脏胸外科医生的死亡率最低（非心脏胸外科为5.1%，心胸外科为5.2%，普通外科为6.1%）（普通外科医生与胸外科医生之间的差异P < 0.01）。在仅限于高手术量医院（每年>45例肺切除术）的分析中，非心脏胸外科医生的死亡率再次最低（非心脏胸外科为5.0%，心胸外科为5.3%，普通外科为6.1%）（三组之间的差异P < 0.01）。
肺切除术后的手术死亡率因外科专业而异。这种手术死亡率的差异部分但并非全部可归因于医院和外科医生的手术量。
