Postoperative Outcomes Among Patients Undergoing Cancer Surgery: United States versus International Medical Graduates
We sought to characterize postoperative outcomes among patients who underwent an oncologic operation relative to whether the treating surgeon was an international medical graduate (IMG) versus a United States medical graduate (USMG). IMGs comprise approximately one-quarter of the physician workforce...
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| Veröffentlicht in: | Annals of surgery 2024-06, Vol.280 (3), p.514 |
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| creator | Khan, Muhammad Muntazir Mehdi Munir, Muhammad Musaab Woldesenbet, Selamawit Khalil, Mujtaba Endo, Yutaka Katayama, Erryk Tsilimigras, Diamantis Rashid, Zayed Altaf, Abdullah Dillhoff, Mary Tsai, Susan Pawlik, Timothy M |
| description | We sought to characterize postoperative outcomes among patients who underwent an oncologic operation relative to whether the treating surgeon was an international medical graduate (IMG) versus a United States medical graduate (USMG).
IMGs comprise approximately one-quarter of the physician workforce in the United States.
The 100% Medicare Standard Analytic Files were utilized to extract data on patients with breast, lung, hepato-pancreato-biliary (HPB), and colorectal cancer who underwent surgical resection between 2014 and 2020. Entropy balancing (EB) and multivariable regression analysis were performed to evaluate the association between postoperative outcomes among USMG and IMG surgeons.
Among 285,930 beneficiaries, 242,914 (85.0%) and 43,016 (15.0%) underwent surgery by a USMG and IMG surgeon, respectively. Overall, 129,576 (45.3%) individuals were male, and 168,848 (59.1%) patients had a Charlson Comorbidity Index score >2. Notably, IMG surgeons were more likely to care for racial/ethnic minority patients (14.7% vs. 12.5%) and those with a high social vulnerability index (33.3% vs. 32.1%) (all P |
| doi_str_mv | 10.1097/SLA.0000000000006384 |
| format | Article |
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IMGs comprise approximately one-quarter of the physician workforce in the United States.
The 100% Medicare Standard Analytic Files were utilized to extract data on patients with breast, lung, hepato-pancreato-biliary (HPB), and colorectal cancer who underwent surgical resection between 2014 and 2020. Entropy balancing (EB) and multivariable regression analysis were performed to evaluate the association between postoperative outcomes among USMG and IMG surgeons.
Among 285,930 beneficiaries, 242,914 (85.0%) and 43,016 (15.0%) underwent surgery by a USMG and IMG surgeon, respectively. Overall, 129,576 (45.3%) individuals were male, and 168,848 (59.1%) patients had a Charlson Comorbidity Index score >2. Notably, IMG surgeons were more likely to care for racial/ethnic minority patients (14.7% vs. 12.5%) and those with a high social vulnerability index (33.3% vs. 32.1%) (all P<0.001). On multivariable analysis after EB, patients treated by an IMG surgeon were less likely to experience adverse postoperative outcomes including 90-day readmission (OR 0.89, 95%CI 0.80-0.99) and index complications (OR 0.84, 95%CI 0.74-0.95) versus USMG surgeons (all P<0.05). Patients treated by IMG versus USMG surgeons had no difference in likelihood to achieve a textbook outcome (OR 1.10, 95%CI 0.99-1.21; P=0.077).
Postoperative outcomes among patients treated by IMG surgeons were roughly equivalent to those of USMG surgeons. In addition, IMG surgeons were more likely to care for patients with multiple comorbidities and individuals from vulnerable communities.</description><identifier>ISSN: 0003-4932</identifier><identifier>ISSN: 1528-1140</identifier><identifier>EISSN: 1528-1140</identifier><identifier>DOI: 10.1097/SLA.0000000000006384</identifier><identifier>PMID: 38860383</identifier><language>eng</language><publisher>United States</publisher><ispartof>Annals of surgery, 2024-06, Vol.280 (3), p.514</ispartof><rights>Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c1013-6e27379e2a90426020df6a8b55f9b252f8dc540b71139f2260cb304abd05b8c03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,27929,27930</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38860383$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Khan, Muhammad Muntazir Mehdi</creatorcontrib><creatorcontrib>Munir, Muhammad Musaab</creatorcontrib><creatorcontrib>Woldesenbet, Selamawit</creatorcontrib><creatorcontrib>Khalil, Mujtaba</creatorcontrib><creatorcontrib>Endo, Yutaka</creatorcontrib><creatorcontrib>Katayama, Erryk</creatorcontrib><creatorcontrib>Tsilimigras, Diamantis</creatorcontrib><creatorcontrib>Rashid, Zayed</creatorcontrib><creatorcontrib>Altaf, Abdullah</creatorcontrib><creatorcontrib>Dillhoff, Mary</creatorcontrib><creatorcontrib>Tsai, Susan</creatorcontrib><creatorcontrib>Pawlik, Timothy M</creatorcontrib><title>Postoperative Outcomes Among Patients Undergoing Cancer Surgery: United States versus International Medical Graduates</title><title>Annals of surgery</title><addtitle>Ann Surg</addtitle><description>We sought to characterize postoperative outcomes among patients who underwent an oncologic operation relative to whether the treating surgeon was an international medical graduate (IMG) versus a United States medical graduate (USMG).
IMGs comprise approximately one-quarter of the physician workforce in the United States.
The 100% Medicare Standard Analytic Files were utilized to extract data on patients with breast, lung, hepato-pancreato-biliary (HPB), and colorectal cancer who underwent surgical resection between 2014 and 2020. Entropy balancing (EB) and multivariable regression analysis were performed to evaluate the association between postoperative outcomes among USMG and IMG surgeons.
Among 285,930 beneficiaries, 242,914 (85.0%) and 43,016 (15.0%) underwent surgery by a USMG and IMG surgeon, respectively. Overall, 129,576 (45.3%) individuals were male, and 168,848 (59.1%) patients had a Charlson Comorbidity Index score >2. Notably, IMG surgeons were more likely to care for racial/ethnic minority patients (14.7% vs. 12.5%) and those with a high social vulnerability index (33.3% vs. 32.1%) (all P<0.001). On multivariable analysis after EB, patients treated by an IMG surgeon were less likely to experience adverse postoperative outcomes including 90-day readmission (OR 0.89, 95%CI 0.80-0.99) and index complications (OR 0.84, 95%CI 0.74-0.95) versus USMG surgeons (all P<0.05). Patients treated by IMG versus USMG surgeons had no difference in likelihood to achieve a textbook outcome (OR 1.10, 95%CI 0.99-1.21; P=0.077).
Postoperative outcomes among patients treated by IMG surgeons were roughly equivalent to those of USMG surgeons. In addition, IMG surgeons were more likely to care for patients with multiple comorbidities and individuals from vulnerable communities.</description><issn>0003-4932</issn><issn>1528-1140</issn><issn>1528-1140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNpdkF9LwzAUxYMobk6_gUgffem8Sfon9W0MnYPJBnPPJU1vR6VtZpIO9u3N2BTxvhw495x74UfIPYUxhSx9Wi8mY_gzCRfRBRnSmImQ0gguydC7PIwyzgbkxtpPABoJSK_JgAuRABd8SPqVtk7v0EhX7zFY9k7pFm0waXW3DVbexc7ZYNOVaLa69t5UdgpNsO7NFs3h2a9qh2WwdtL53h6N7W0w7xyazrd1J5vgHctaeZ0ZWfbH2C25qmRj8e6sI7J5ffmYvoWL5Ww-nSxCRYHyMEGW8jRDJjOIWAIMyiqRoojjKitYzCpRqjiCIqWUZxXzCVVwiGRRQlwIBXxEHk93d0Z_9Whd3tZWYdPIDnVvcw5JkmYgeOaj0SmqjLbWYJXvTN1Kc8gp5EfguQee_wfuaw_nD33RYvlb-iHMvwFgunxs</recordid><startdate>20240611</startdate><enddate>20240611</enddate><creator>Khan, Muhammad Muntazir Mehdi</creator><creator>Munir, Muhammad Musaab</creator><creator>Woldesenbet, Selamawit</creator><creator>Khalil, Mujtaba</creator><creator>Endo, Yutaka</creator><creator>Katayama, Erryk</creator><creator>Tsilimigras, Diamantis</creator><creator>Rashid, Zayed</creator><creator>Altaf, Abdullah</creator><creator>Dillhoff, Mary</creator><creator>Tsai, Susan</creator><creator>Pawlik, Timothy M</creator><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20240611</creationdate><title>Postoperative Outcomes Among Patients Undergoing Cancer Surgery: United States versus International Medical Graduates</title><author>Khan, Muhammad Muntazir Mehdi ; Munir, Muhammad Musaab ; Woldesenbet, Selamawit ; Khalil, Mujtaba ; Endo, Yutaka ; Katayama, Erryk ; Tsilimigras, Diamantis ; Rashid, Zayed ; Altaf, Abdullah ; Dillhoff, Mary ; Tsai, Susan ; Pawlik, Timothy M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1013-6e27379e2a90426020df6a8b55f9b252f8dc540b71139f2260cb304abd05b8c03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Khan, Muhammad Muntazir Mehdi</creatorcontrib><creatorcontrib>Munir, Muhammad Musaab</creatorcontrib><creatorcontrib>Woldesenbet, Selamawit</creatorcontrib><creatorcontrib>Khalil, Mujtaba</creatorcontrib><creatorcontrib>Endo, Yutaka</creatorcontrib><creatorcontrib>Katayama, Erryk</creatorcontrib><creatorcontrib>Tsilimigras, Diamantis</creatorcontrib><creatorcontrib>Rashid, Zayed</creatorcontrib><creatorcontrib>Altaf, Abdullah</creatorcontrib><creatorcontrib>Dillhoff, Mary</creatorcontrib><creatorcontrib>Tsai, Susan</creatorcontrib><creatorcontrib>Pawlik, Timothy M</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Khan, Muhammad Muntazir Mehdi</au><au>Munir, Muhammad Musaab</au><au>Woldesenbet, Selamawit</au><au>Khalil, Mujtaba</au><au>Endo, Yutaka</au><au>Katayama, Erryk</au><au>Tsilimigras, Diamantis</au><au>Rashid, Zayed</au><au>Altaf, Abdullah</au><au>Dillhoff, Mary</au><au>Tsai, Susan</au><au>Pawlik, Timothy M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Postoperative Outcomes Among Patients Undergoing Cancer Surgery: United States versus International Medical Graduates</atitle><jtitle>Annals of surgery</jtitle><addtitle>Ann Surg</addtitle><date>2024-06-11</date><risdate>2024</risdate><volume>280</volume><issue>3</issue><spage>514</spage><pages>514-</pages><issn>0003-4932</issn><issn>1528-1140</issn><eissn>1528-1140</eissn><abstract>We sought to characterize postoperative outcomes among patients who underwent an oncologic operation relative to whether the treating surgeon was an international medical graduate (IMG) versus a United States medical graduate (USMG).
IMGs comprise approximately one-quarter of the physician workforce in the United States.
The 100% Medicare Standard Analytic Files were utilized to extract data on patients with breast, lung, hepato-pancreato-biliary (HPB), and colorectal cancer who underwent surgical resection between 2014 and 2020. Entropy balancing (EB) and multivariable regression analysis were performed to evaluate the association between postoperative outcomes among USMG and IMG surgeons.
Among 285,930 beneficiaries, 242,914 (85.0%) and 43,016 (15.0%) underwent surgery by a USMG and IMG surgeon, respectively. Overall, 129,576 (45.3%) individuals were male, and 168,848 (59.1%) patients had a Charlson Comorbidity Index score >2. Notably, IMG surgeons were more likely to care for racial/ethnic minority patients (14.7% vs. 12.5%) and those with a high social vulnerability index (33.3% vs. 32.1%) (all P<0.001). On multivariable analysis after EB, patients treated by an IMG surgeon were less likely to experience adverse postoperative outcomes including 90-day readmission (OR 0.89, 95%CI 0.80-0.99) and index complications (OR 0.84, 95%CI 0.74-0.95) versus USMG surgeons (all P<0.05). Patients treated by IMG versus USMG surgeons had no difference in likelihood to achieve a textbook outcome (OR 1.10, 95%CI 0.99-1.21; P=0.077).
Postoperative outcomes among patients treated by IMG surgeons were roughly equivalent to those of USMG surgeons. In addition, IMG surgeons were more likely to care for patients with multiple comorbidities and individuals from vulnerable communities.</abstract><cop>United States</cop><pmid>38860383</pmid><doi>10.1097/SLA.0000000000006384</doi></addata></record> |
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| title | Postoperative Outcomes Among Patients Undergoing Cancer Surgery: United States versus International Medical Graduates |
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