East Bay Department of Surgery, University of California, San Francisco, Oakland, CA, USA.
Department of Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.
Am Surg. 2023 May;89(5):1546-1553. doi: 10.1177/00031348211065117. Epub 2021 Dec 29.
A few observational studies have found that outcomes after esophagectomies by thoracic surgeons are better than those by general surgeons.
Non-emergent esophagectomy cases were identified in the 2016-2017 American College of Surgeons NSQIP database. Associations between patient characteristics and outcomes by thoracic versus general surgeons were evaluated with univariate and multivariate logistic regression.
Of 1,606 cases, 886 (55.2%) were performed by thoracic surgeons. Those patients differed from patients treated by general surgeons in race (other/unknown 19.3% vs 7.8%; P<.001) but not in other baseline characteristics (age, sex, BMI, and comorbidities). Thoracic surgeons performed an open approach more frequently (48.9% vs 30.8%, P<.001) and had operative times that were 30 minutes shorter (P<.001). General surgeons had lower rates of reoperation (11.8% vs 17.2%; P=.003) and were more likely to treat postoperative leak with interventional means (6.3% vs 3.4%, P=.01). Thoracic surgeons were more likely to treat postoperative leak with reoperation (5.9% vs 3.6%, P=.01). There were no other differences in univariate comparison of outcomes between the two groups, including leak, readmission, and death. General surgery specialty was associated with lower risk of reoperation. Our multivariable model also found no relationship between general surgeon and risk of any complication (odds ratio 1.10; 95% CI .86 to 1.42).
In our large, national database study, we found that outcomes of esophagectomies by general surgeons were comparable with those by thoracic surgeons. General surgeons managed postoperative leaks differently than thoracic surgeons.
几项观察性研究发现，胸外科医生进行的食管切除术的结果优于普通外科医生。
在 2016-2017 年美国外科医师学会 NSQIP 数据库中确定了非紧急食管切除术病例。使用单变量和多变量逻辑回归评估了患者特征与胸外科医生和普通外科医生手术结果之间的关系。
在 1606 例患者中，886 例（55.2%）由胸外科医生进行手术。这些患者与普通外科医生治疗的患者在种族方面存在差异（其他/未知 19.3%对 7.8%；P<.001），但在其他基线特征（年龄、性别、BMI 和合并症）方面无差异。胸外科医生更常采用开放入路（48.9%对 30.8%，P<.001），手术时间缩短 30 分钟（P<.001）。普通外科医生的再次手术率较低（11.8%对 17.2%；P=.003），更倾向于通过介入手段治疗术后漏（6.3%对 3.4%，P=.01）。胸外科医生更倾向于通过再次手术治疗术后漏（5.9%对 3.6%，P=.01）。在两组之间，包括漏、再入院和死亡在内的结果的单变量比较中没有其他差异。普通外科手术专业与较低的再次手术风险相关。我们的多变量模型也没有发现普通外科医生与任何并发症风险之间的关系（比值比 1.10；95%CI.86 至 1.42）。
在我们的大型全国性数据库研究中，我们发现普通外科医生进行的食管切除术的结果与胸外科医生相当。普通外科医生处理术后漏的方法与胸外科医生不同。
