Patient Safety/Quality

Patients of thoracic surgeons are less likely to die after lung cancer surgery than those of general surgeons, but volume counts

A recent study supported by the Agency for Healthcare Research and Quality (HS10141) found that Medicare patients of cardiothoracic surgeons and noncardiac thoracic surgeons (who perform only lung surgery) were 2 percent less likely to die within 30 days of surgery for lung cancer than similar patients of general surgeons. However, this difference was reduced somewhat among high-volume surgeons and in high-volume hospitals, with all high-volume surgeons having excellent outcomes, notes John D. Birkmeyer, M.D., of the University of Michigan.

Dr. Birkmeyer and his colleagues analyzed 1998-1999 Medicare data on patients undergoing lung resection (lobectomy, removal of one or more lung lobes, and pneumonectomy, removal of an entire lung) for lung cancer. They compared operative mortality for patients of general surgeons, cardiothoracic surgeons, and noncardiac thoracic surgeons, after adjusting for patient, surgeon, and hospital characteristics.

Overall, 25,545 Medicare patients underwent lung resection. Adjusted operative mortality rates were about 2 percent higher for generalist surgeons (7.6 percent) compared with cardiothoracic surgeons (5.6 percent) and noncardiac thoracic surgeons (5.8 percent). Just taking into account high-volume surgeons (who performed more than 20 lung resections per year), mortality rates were lower for noncardiac thoracic surgeons (5.1 percent) and cardiothoracic surgeons (5.2 percent) than general surgeons (6.1 percent). In an analysis restricted to high-volume hospitals (more than 45 lung resections per year), mortality rates were again lower for noncardiac thoracic surgeons (5 percent) and cardiothoracic surgeons (5.3 percent) than general surgeons (6.1 percent).

See "Surgeon specialty and operative mortality with lung resection," by Philip P. Goodney, M.D., F.L. Lucas, M.D., Therese A. Stukel, Ph.D., and Dr. Birkmeyer, in the January 2005 Annals of Surgery 241(1), pp. 179-184.

Editor's Note: Another AHRQ-supported study on a related topic found that patients undergoing surgery for different types of cancer at National Cancer Institute-designated cancer centers had lower surgical mortality rates than those treated at comparably high-volume hospitals, but long-term survival rates were similar. For more details, see Birkmeyer, N.J., Goodney, P.P., Stukel, T.A., and others (2005, February). "Do cancer centers designated by the National Cancer Institute have better surgical outcomes?" (AHRQ grant HS11288). Cancer 103, pp. 435-441.

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