Cardiovascular Outcomes Research Laboratories (CORELAB), University of California, Los Angeles, Los Angeles, CA, USA.
Department of Surgery, University of California, Los Angeles, Los Angeles, CA, USA.
Surg Endosc. 2023 Nov;37(11):8309-8315. doi: 10.1007/s00464-023-10391-5. Epub 2023 Sep 7.
The impact of surgeon and hospital operative volume on esophagectomy outcomes is well-described; however, studies examining the influence of surgeon specialty remain limited. Therefore, we evaluated the impact of surgeon specialty on short-term outcomes following esophagectomy for cancer.
The 2016-2019 American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) was queried to identify all patients undergoing esophagectomy for esophageal cancer. Surgeon specialty was categorized as general (GS) or thoracic (TS). Entropy balancing was used to generate sample weights that adjust for baseline differences between GS and TS patients. Weights were subsequently applied to multivariable linear and logistic regressions, which were used to evaluate the independent association of surgeon specialty with 30-day mortality, complications, and postoperative length of stay.
Of 2657 esophagectomies included for analysis, 54.1% were performed by TS. Both groups had similar distributions of age, sex, and body mass index. TS patients more frequently underwent transthoracic esophagectomy, while GS patients more commonly received minimally invasive surgery. After adjustment, surgeon specialty was not associated with altered odds of 30-day mortality (adjusted odds ratio [AOR] 1.10 p = 0.73) or anastomotic leak (AOR 0.87, p = 0.33). However, TS patients exhibited a 40-min reduction in operative duration and faced greater odds of perioperative transfusion, relative to GS.
Among ACS NSQIP participating centers, surgeon specialty influenced operative duration and blood product utilization, but not mortality and anastomotic leak. Our results support the relative safety of esophagectomy performed by select GS and TS.
外科医生和医院手术量对食管癌手术结果的影响已有详细描述；然而，研究检查外科医生专业对食管癌手术后短期结果的影响仍然有限。因此，我们评估了外科医生专业对食管癌手术后短期结果的影响。
美国外科医师学会国家手术质量改进计划（ACS NSQIP）的 2016-2019 年数据被用来识别所有接受食管癌切除术的患者。外科医生的专业被分为普通外科（GS）或胸外科（TS）。使用熵平衡来生成样本权重，以调整 GS 和 TS 患者之间的基线差异。随后将权重应用于多变量线性和逻辑回归，用于评估外科医生专业与 30 天死亡率、并发症和术后住院时间的独立关联。
在纳入分析的 2657 例食管癌切除术患者中，54.1%由 TS 完成。两组的年龄、性别和体重指数分布相似。TS 患者更常接受经胸食管切除术，而 GS 患者更常接受微创手术。调整后，外科医生专业与 30 天死亡率（调整后的优势比 [AOR] 1.10，p = 0.73）或吻合口漏（AOR 0.87，p = 0.33）的改变无关。然而，与 GS 相比，TS 患者的手术时间缩短了 40 分钟，并且围手术期输血的几率更大。
在 ACS NSQIP 参与中心，外科医生专业影响手术时间和血液制品的使用，但不影响死亡率和吻合口漏。我们的结果支持选择性 GS 和 TS 进行食管癌切除术的相对安全性。
