Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Surg Today. 2021 Aug;51(8):1268-1275. doi: 10.1007/s00595-021-02227-3. Epub 2021 Jan 30.
We investigated the association between the number of certified general thoracic surgeons (GTSs) and the mortality after lung cancer surgery, based on the data from the National Clinical Database (NCD).
We analyzed the characteristics and operative and postoperative data of 120,946 patients who underwent lung cancer surgery in one of the 905 hospitals in Japan. The number of GTSs in each hospital was categorized as 0, 1-2, or 3 or more. Multivariable analysis was applied to adjust the patients' preoperative risk factors, as identified in a previous study. We calculated 95% confidence intervals (CI) for the mortality rate based on the odds ratios (ORs).
The patients' characteristics were distributed almost uniformly regardless of the number of GTSs. Crude mortality according to the number of GTSs of 0, 1-2, or 3 or more was 0.9%, 0.8%, and 0.7%, respectively (p = 0.03). However, after adjustment, the ORs for 1-2 and 3 or more GTSs (reference: 0) were 0.86 (p = 0.23, 95% CI: 0.67-1.10) and 0.84 (p = 0.18, 95% CI: 0.64-1.09), respectively. The number of GTSs did not have a significant association with mortality. Similar results were observed for patients in the lobectomy cohort.
Low surgical mortality was consistent, regardless of the number of GTSs in each hospital.
我们基于国家临床数据库（NCD）的数据，研究了认证普通胸外科医师（GTS）数量与肺癌手术后死亡率之间的关系。
我们分析了日本 905 家医院之一的 120946 例肺癌手术患者的特征和手术及术后数据。每家医院的 GTS 数量分为 0、1-2 或 3 个或更多。多变量分析用于调整患者的术前危险因素，这些危险因素在之前的研究中已经确定。我们根据优势比（OR）计算死亡率的 95%置信区间（CI）。
无论 GTS 数量多少，患者的特征分布几乎均匀。根据 GTS 数量为 0、1-2 或 3 个或更多的粗死亡率分别为 0.9%、0.8%和 0.7%（p=0.03）。然而，调整后，1-2 个和 3 个或更多 GTS 的 OR（参考：0）分别为 0.86（p=0.23，95%CI：0.67-1.10）和 0.84（p=0.18，95%CI：0.64-1.09）。GTS 数量与死亡率之间没有显著关系。在肺叶切除术队列中也观察到了类似的结果。
无论每家医院的 GTS 数量多少，手术死亡率都较低且一致。
