Department of Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USA.
Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue Cleveland, Cleveland, OH 44106, USA.
Curr Oncol. 2023 Feb 27;30(3):2801-2811. doi: 10.3390/curroncol30030213.
Lung lobectomy is the standard of care for early-stage lung cancer. Studies have suggested improved outcomes associated with lobectomy performed by specialized thoracic surgery providers. We hypothesized that disparities would exist regarding access to thoracic surgeons among patients receiving lung lobectomy for cancer.
The Premier Hospital Database was used to identify adult inpatients receiving lung lobectomy from 2009 to 2019. Patients were categorized as receiving their lobectomy from a thoracic surgeon, cardiovascular surgeon, or general surgeon. Sample-weighted multivariable analysis was performed to identify factors associated with provider type.
When adjusted for sampling, 121,711 patients were analyzed, including 71,709 (58.9%) who received lobectomy by a thoracic surgeon, 36,630 (30.1%) by a cardiovascular surgeon, and 13,373 (11.0%) by a general surgeon. Multivariable analysis showed that thoracic surgeon provider type was less likely with Black patients, Medicaid insurance, smaller hospital size, in the western region, and in rural areas. In addition, non-thoracic surgery specialty was less likely to perform minimally-invasive (MIS) lobectomy (cardiovascular OR 0.80, < 0.001, general surgery OR 0.85, = 0.003).
In this nationally representative analysis, smaller, rural, non-teaching hospitals, and certain regions of the United States are less likely to receive lobectomy from a thoracic surgeon. Thoracic surgeon specialization is also independently associated with utilization of minimally invasive lobectomy. Combined, there are significant disparities in access to guideline-directed surgical care of patients receiving lung lobectomy.
肺叶切除术是早期肺癌的标准治疗方法。研究表明，由专业胸外科医生进行的肺叶切除术与更好的治疗效果相关。我们假设，在接受肺癌肺叶切除术的患者中，接受胸外科医生治疗的机会存在差异。
利用 Premier 医院数据库，确定了 2009 年至 2019 年期间接受肺叶切除术的成年住院患者。患者分为接受胸外科医生、心血管外科医生或普通外科医生进行肺叶切除术。采用样本加权多变量分析来确定与提供者类型相关的因素。
调整抽样后，共分析了 121711 名患者，其中 71709 名（58.9%）患者由胸外科医生进行肺叶切除术，36630 名（30.1%）患者由心血管外科医生进行肺叶切除术，13373 名（11.0%）患者由普通外科医生进行肺叶切除术。多变量分析表明，黑人患者、医疗补助保险、医院规模较小、西部地区和农村地区接受胸外科医生治疗的可能性较低。此外，非胸外科专业进行微创（MIS）肺叶切除术的可能性较低（心血管外科医生 OR 0.80， < 0.001，普通外科医生 OR 0.85， = 0.003）。
在这项具有全国代表性的分析中，较小的、农村的、非教学医院以及美国某些地区接受胸外科医生治疗的可能性较低。胸外科医生的专业化也与微创肺叶切除术的应用独立相关。综合来看，接受肺叶切除术的患者在获得指南指导的手术治疗方面存在显著差异。
