Chest
clinical investigationsSpecialists Achieve Better Outcomes Than Generalists for Lung Cancer Surgery
Section snippets
Data Source
The State Budget and Control Board's Office of Research and Statistics (ORS) captures discharge information from every hospitalization to all nonfederal acute care hospitals within the state. Each discharge record includes demographic and geographic characteristics of the patient, primary discharge diagnosis, and up to nine secondary diagnoses (International Classification of Diseases, ninth revision, Clinical Manual) (ICD-9-CM), including both comorbidities and complications, principal
RESULTS
Between 1991 and 1995, there were 1,720 resections performed for lung cancer in South Carolina. Only procedures performed by a board-certified GS or TS were included in this study. One hundred thirty-seven patients (95 had lobectomies and 37 had pneumonectomies) were excluded from analysis because they were operated on by surgeons who did not meet the defined certification criteria for GS or TS. Analysis of this group yielded mortality results similar to GSs (data not shown). The number of
DISCUSSION
The significant findings of this study include the delineation of the demographics of lung cancer surgery in a rural state and a difference in provider specific outcome in the performance of this surgery. More than half of the resections for bronchogenic carcinoma in South Carolina are performed by GSs. Most GSs performed few pulmonary resections. This contrasts to TSs where fewer surgeons perform the majority of cases. Mortality was higher for patients who underwent lobectomy by GSs. This
ACKNOWLEDGMENTS
The authors wish to acknowledge Mary D. Pease, MA, and Wesley Kemmerlin, MPH, for their assistance with the database and statistical support. We are also indebted to Fred A. Crawford, MD, for his thoughtful insight into this work.
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Manuscript received October 14, 1997; revision accepted January 13, 1998.