Specialists Achieve Better Outcomes Than Generalists for Lung Cancer Surgery
Objective: A push toward care provided by generalists as opposed to specialists has occurred in the health-care marketplace despite a lack of provider specific outcome data. The objective of this study was to determine whether the outcome of patients undergoing lung cancer surgery is different betwe...
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| Veröffentlicht in: | Chest 1998-09, Vol.114 (3), p.675-680 |
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| creator | Silvestri, Gerard A. Handy, John Lackland, Daniel Corley, Elizabeth Reed, Carolyn E. |
| description | Objective: A push toward care provided by generalists as opposed to specialists has occurred in the health-care marketplace despite a lack of provider specific outcome data. The objective of this study was to determine whether the outcome of patients undergoing lung cancer surgery is different between general surgeons (GSs) and thoracic surgeons (TSs).
Design: Examination of data from a state-wide severity-adjusted administrative hospital discharge database.
Setting/participants: Patients undergoing lung cancer resection in all nonfederal acute care hospitals within South Carolina.
Main outcome measures: Mortality by speciality adjusted for case mix.
Results: From 1991 to 1995, 1,720 resections for lung cancer were performed in South Carolina. One hundred thirty-seven cases were excluded because surgeons did not meet the predefined criteria for board certification, leaving 1,583 resections for analysis. One-half of lobectomies and nearly 60% of pneumonectomies were performed by GSs. Patients were similar in age, sex, gender, race, and the proportion in each severity of illness subclass. Mortality was significantly higher in patients who underwent lobectomy by GSs vs TSs (5.3% vs 3.0%; p65 years (7.4% vs 3.5%; p 10 cases in the series, whereas 75% of GSs performed < 10 (p=0.05). Logistic regression analysis failed to identify any significant variable that might explain the mortality differences between TSs and GSs.
Conclusion: Mortality is lower for lung cancer resection when the surgery is performed by a TS.
(CHEST 1998; 114:675-680)
Abbreviations: APR-DRG=all patient refined diagnostic related group; CAB=coronary artery bypass; GS=general surgeon; ICD-9=International Classification of Diseases, ninth revision; ORS=Office of Research and Statistics; TS=thoracic surgeon |
| doi_str_mv | 10.1378/chest.114.3.675 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_73907285</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0012369216325636</els_id><sourcerecordid>34123002</sourcerecordid><originalsourceid>FETCH-LOGICAL-c533t-b852c0566b8f586459f4d4b2bcbe49435a11ffeba21a8895b829bedc0f5f96f53</originalsourceid><addsrcrecordid>eNp1kU1r3DAQhkVoSDdpzzkVTAm5eaNPWzqmS5sWFnJIchaSPFor-GMr2Sn591G6Ji2FnoSYZ2ZenkHonOA1YbW8ci2kaU0IX7N1VYsjtCKKkZIJzt6hFcaElqxS9D06TekR5z9R1Qk6UTVnhKsV2t7twQXThTSl4tq1AZ6g-ALTBLG4nSc39pCK-9YMxQ0MEBfQj7HYzsOu2JjBZfJujjuIzx_QsTddgo_Le4Yevn2933wvt7c3PzbX29IJxqbSSkEdFlVlpRey4kJ53nBLrbPAFWfCEOI9WEOJkVIJK6my0DjshVeVF-wMXR7m7uP4c84CdB-Sg64zA4xz0jVTuKbyFfz8D_g4znHI2TTFmNdKcJqhqwPk4phSBK_3MfQmPmuC9atk_VuyzpI101ly7vi0jJ1tD80bv1jN9YulbpIznY_ZUkhvGM3xuCR_Frdh1_4KEXTqTdfloeywcgn792J16IBs9ylA1MkFyCdocrebdDOG_4Z-AbRHqZc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>200479542</pqid></control><display><type>article</type><title>Specialists Achieve Better Outcomes Than Generalists for Lung Cancer Surgery</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Silvestri, Gerard A. ; Handy, John ; Lackland, Daniel ; Corley, Elizabeth ; Reed, Carolyn E.</creator><creatorcontrib>Silvestri, Gerard A. ; Handy, John ; Lackland, Daniel ; Corley, Elizabeth ; Reed, Carolyn E.</creatorcontrib><description>Objective: A push toward care provided by generalists as opposed to specialists has occurred in the health-care marketplace despite a lack of provider specific outcome data. The objective of this study was to determine whether the outcome of patients undergoing lung cancer surgery is different between general surgeons (GSs) and thoracic surgeons (TSs).
Design: Examination of data from a state-wide severity-adjusted administrative hospital discharge database.
Setting/participants: Patients undergoing lung cancer resection in all nonfederal acute care hospitals within South Carolina.
Main outcome measures: Mortality by speciality adjusted for case mix.
Results: From 1991 to 1995, 1,720 resections for lung cancer were performed in South Carolina. One hundred thirty-seven cases were excluded because surgeons did not meet the predefined criteria for board certification, leaving 1,583 resections for analysis. One-half of lobectomies and nearly 60% of pneumonectomies were performed by GSs. Patients were similar in age, sex, gender, race, and the proportion in each severity of illness subclass. Mortality was significantly higher in patients who underwent lobectomy by GSs vs TSs (5.3% vs 3.0%; p<0.05) and in patients with extreme comorbidities (43.6% vs 25.4%; p=0.03) or age >65 years (7.4% vs 3.5%; p<0.05). Seventy percent of TSs performed > 10 cases in the series, whereas 75% of GSs performed < 10 (p=0.05). Logistic regression analysis failed to identify any significant variable that might explain the mortality differences between TSs and GSs.
Conclusion: Mortality is lower for lung cancer resection when the surgery is performed by a TS.
(CHEST 1998; 114:675-680)
Abbreviations: APR-DRG=all patient refined diagnostic related group; CAB=coronary artery bypass; GS=general surgeon; ICD-9=International Classification of Diseases, ninth revision; ORS=Office of Research and Statistics; TS=thoracic surgeon</description><identifier>ISSN: 0012-3692</identifier><identifier>EISSN: 1931-3543</identifier><identifier>DOI: 10.1378/chest.114.3.675</identifier><identifier>PMID: 9743149</identifier><identifier>CODEN: CHETBF</identifier><language>eng</language><publisher>Northbrook, IL: Elsevier Inc</publisher><subject>Biological and medical sciences ; Female ; General Surgery ; generalist ; Humans ; lobectomy ; Lung cancer ; Lung Neoplasms - mortality ; Lung Neoplasms - surgery ; Male ; Medical sciences ; Middle Aged ; outcomes ; Pneumology ; pneumonectomy ; Pneumonectomy - adverse effects ; Pneumonectomy - mortality ; specialist ; surgery ; Survival Rate ; Thoracic Surgery ; Treatment Outcome ; Tumors of the respiratory system and mediastinum</subject><ispartof>Chest, 1998-09, Vol.114 (3), p.675-680</ispartof><rights>1998 The American College of Chest Physicians</rights><rights>1998 INIST-CNRS</rights><rights>Copyright American College of Chest Physicians Sep 1998</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c533t-b852c0566b8f586459f4d4b2bcbe49435a11ffeba21a8895b829bedc0f5f96f53</citedby><cites>FETCH-LOGICAL-c533t-b852c0566b8f586459f4d4b2bcbe49435a11ffeba21a8895b829bedc0f5f96f53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2390481$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9743149$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Silvestri, Gerard A.</creatorcontrib><creatorcontrib>Handy, John</creatorcontrib><creatorcontrib>Lackland, Daniel</creatorcontrib><creatorcontrib>Corley, Elizabeth</creatorcontrib><creatorcontrib>Reed, Carolyn E.</creatorcontrib><title>Specialists Achieve Better Outcomes Than Generalists for Lung Cancer Surgery</title><title>Chest</title><addtitle>Chest</addtitle><description>Objective: A push toward care provided by generalists as opposed to specialists has occurred in the health-care marketplace despite a lack of provider specific outcome data. The objective of this study was to determine whether the outcome of patients undergoing lung cancer surgery is different between general surgeons (GSs) and thoracic surgeons (TSs).
Design: Examination of data from a state-wide severity-adjusted administrative hospital discharge database.
Setting/participants: Patients undergoing lung cancer resection in all nonfederal acute care hospitals within South Carolina.
Main outcome measures: Mortality by speciality adjusted for case mix.
Results: From 1991 to 1995, 1,720 resections for lung cancer were performed in South Carolina. One hundred thirty-seven cases were excluded because surgeons did not meet the predefined criteria for board certification, leaving 1,583 resections for analysis. One-half of lobectomies and nearly 60% of pneumonectomies were performed by GSs. Patients were similar in age, sex, gender, race, and the proportion in each severity of illness subclass. Mortality was significantly higher in patients who underwent lobectomy by GSs vs TSs (5.3% vs 3.0%; p<0.05) and in patients with extreme comorbidities (43.6% vs 25.4%; p=0.03) or age >65 years (7.4% vs 3.5%; p<0.05). Seventy percent of TSs performed > 10 cases in the series, whereas 75% of GSs performed < 10 (p=0.05). Logistic regression analysis failed to identify any significant variable that might explain the mortality differences between TSs and GSs.
Conclusion: Mortality is lower for lung cancer resection when the surgery is performed by a TS.
(CHEST 1998; 114:675-680)
Abbreviations: APR-DRG=all patient refined diagnostic related group; CAB=coronary artery bypass; GS=general surgeon; ICD-9=International Classification of Diseases, ninth revision; ORS=Office of Research and Statistics; TS=thoracic surgeon</description><subject>Biological and medical sciences</subject><subject>Female</subject><subject>General Surgery</subject><subject>generalist</subject><subject>Humans</subject><subject>lobectomy</subject><subject>Lung cancer</subject><subject>Lung Neoplasms - mortality</subject><subject>Lung Neoplasms - surgery</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>outcomes</subject><subject>Pneumology</subject><subject>pneumonectomy</subject><subject>Pneumonectomy - adverse effects</subject><subject>Pneumonectomy - mortality</subject><subject>specialist</subject><subject>surgery</subject><subject>Survival Rate</subject><subject>Thoracic Surgery</subject><subject>Treatment Outcome</subject><subject>Tumors of the respiratory system and mediastinum</subject><issn>0012-3692</issn><issn>1931-3543</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1998</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kU1r3DAQhkVoSDdpzzkVTAm5eaNPWzqmS5sWFnJIchaSPFor-GMr2Sn591G6Ji2FnoSYZ2ZenkHonOA1YbW8ci2kaU0IX7N1VYsjtCKKkZIJzt6hFcaElqxS9D06TekR5z9R1Qk6UTVnhKsV2t7twQXThTSl4tq1AZ6g-ALTBLG4nSc39pCK-9YMxQ0MEBfQj7HYzsOu2JjBZfJujjuIzx_QsTddgo_Le4Yevn2933wvt7c3PzbX29IJxqbSSkEdFlVlpRey4kJ53nBLrbPAFWfCEOI9WEOJkVIJK6my0DjshVeVF-wMXR7m7uP4c84CdB-Sg64zA4xz0jVTuKbyFfz8D_g4znHI2TTFmNdKcJqhqwPk4phSBK_3MfQmPmuC9atk_VuyzpI101ly7vi0jJ1tD80bv1jN9YulbpIznY_ZUkhvGM3xuCR_Frdh1_4KEXTqTdfloeywcgn792J16IBs9ylA1MkFyCdocrebdDOG_4Z-AbRHqZc</recordid><startdate>19980901</startdate><enddate>19980901</enddate><creator>Silvestri, Gerard A.</creator><creator>Handy, John</creator><creator>Lackland, Daniel</creator><creator>Corley, Elizabeth</creator><creator>Reed, Carolyn E.</creator><general>Elsevier Inc</general><general>American College of Chest Physicians</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>19980901</creationdate><title>Specialists Achieve Better Outcomes Than Generalists for Lung Cancer Surgery</title><author>Silvestri, Gerard A. ; Handy, John ; Lackland, Daniel ; Corley, Elizabeth ; Reed, Carolyn E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c533t-b852c0566b8f586459f4d4b2bcbe49435a11ffeba21a8895b829bedc0f5f96f53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1998</creationdate><topic>Biological and medical sciences</topic><topic>Female</topic><topic>General Surgery</topic><topic>generalist</topic><topic>Humans</topic><topic>lobectomy</topic><topic>Lung cancer</topic><topic>Lung Neoplasms - mortality</topic><topic>Lung Neoplasms - surgery</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>outcomes</topic><topic>Pneumology</topic><topic>pneumonectomy</topic><topic>Pneumonectomy - adverse effects</topic><topic>Pneumonectomy - mortality</topic><topic>specialist</topic><topic>surgery</topic><topic>Survival Rate</topic><topic>Thoracic Surgery</topic><topic>Treatment Outcome</topic><topic>Tumors of the respiratory system and mediastinum</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Silvestri, Gerard A.</creatorcontrib><creatorcontrib>Handy, John</creatorcontrib><creatorcontrib>Lackland, Daniel</creatorcontrib><creatorcontrib>Corley, Elizabeth</creatorcontrib><creatorcontrib>Reed, Carolyn E.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Chest</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Silvestri, Gerard A.</au><au>Handy, John</au><au>Lackland, Daniel</au><au>Corley, Elizabeth</au><au>Reed, Carolyn E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Specialists Achieve Better Outcomes Than Generalists for Lung Cancer Surgery</atitle><jtitle>Chest</jtitle><addtitle>Chest</addtitle><date>1998-09-01</date><risdate>1998</risdate><volume>114</volume><issue>3</issue><spage>675</spage><epage>680</epage><pages>675-680</pages><issn>0012-3692</issn><eissn>1931-3543</eissn><coden>CHETBF</coden><abstract>Objective: A push toward care provided by generalists as opposed to specialists has occurred in the health-care marketplace despite a lack of provider specific outcome data. The objective of this study was to determine whether the outcome of patients undergoing lung cancer surgery is different between general surgeons (GSs) and thoracic surgeons (TSs).
Design: Examination of data from a state-wide severity-adjusted administrative hospital discharge database.
Setting/participants: Patients undergoing lung cancer resection in all nonfederal acute care hospitals within South Carolina.
Main outcome measures: Mortality by speciality adjusted for case mix.
Results: From 1991 to 1995, 1,720 resections for lung cancer were performed in South Carolina. One hundred thirty-seven cases were excluded because surgeons did not meet the predefined criteria for board certification, leaving 1,583 resections for analysis. One-half of lobectomies and nearly 60% of pneumonectomies were performed by GSs. Patients were similar in age, sex, gender, race, and the proportion in each severity of illness subclass. Mortality was significantly higher in patients who underwent lobectomy by GSs vs TSs (5.3% vs 3.0%; p<0.05) and in patients with extreme comorbidities (43.6% vs 25.4%; p=0.03) or age >65 years (7.4% vs 3.5%; p<0.05). Seventy percent of TSs performed > 10 cases in the series, whereas 75% of GSs performed < 10 (p=0.05). Logistic regression analysis failed to identify any significant variable that might explain the mortality differences between TSs and GSs.
Conclusion: Mortality is lower for lung cancer resection when the surgery is performed by a TS.
(CHEST 1998; 114:675-680)
Abbreviations: APR-DRG=all patient refined diagnostic related group; CAB=coronary artery bypass; GS=general surgeon; ICD-9=International Classification of Diseases, ninth revision; ORS=Office of Research and Statistics; TS=thoracic surgeon</abstract><cop>Northbrook, IL</cop><pub>Elsevier Inc</pub><pmid>9743149</pmid><doi>10.1378/chest.114.3.675</doi><tpages>6</tpages></addata></record> |
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| subjects | Biological and medical sciences Female General Surgery generalist Humans lobectomy Lung cancer Lung Neoplasms - mortality Lung Neoplasms - surgery Male Medical sciences Middle Aged outcomes Pneumology pneumonectomy Pneumonectomy - adverse effects Pneumonectomy - mortality specialist surgery Survival Rate Thoracic Surgery Treatment Outcome Tumors of the respiratory system and mediastinum |
| title | Specialists Achieve Better Outcomes Than Generalists for Lung Cancer Surgery |
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