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Length of Stay after Lung Cancer Surgery: Thoracic Surgeons Are Setting the Standard
R. A. Meguid, S. M. Cattaneo, M. V. Brock, S. C. Yang. Johns Hopkins University School of Medicine, Baltimore, MD,
BACKGROUND:
Debate exists over the importance of common thoracic operations being performed by thoracic-trained surgeons, as opposed to general surgeons. Analysis of national data has demonstrated decreased perioperative mortality after lung cancer resection by thoracic surgeons versus general surgeons. Length of stay (LOS) has been proposed as an outcome measure in performance improvement programs. We hypothesize that LOS is shorter after lung cancer surgery performed by thoracic surgeons versus general surgeons.
METHODS:
The Nationwide Inpatient Sample dataset (representing 20% of hospital admissions in the U.S. between 1998 and 2005), was enriched using data from the Accreditation Council for Graduate Medical Education on hospitals with thoracic surgery fellowship programs, to identify reliably presence of thoracic surgeons at hospitals. Differences in LOS were compared between lung cancer patients treated surgically at hospitals with thoracic surgery residencies, and those without, adjusting for variables of patient age, gender, race, Charlson index of comorbidities patient demographics, and discharge destination.
RESULTS:
Of 45,991 patients who underwent lung resection (5,752 segmentectomies, 36,522 lobectomies, 4,005 pneumonectomies), 1,406 resections (3%) were performed at hospitals with thoracic surgery residencies. Median LOS of all patients at all hospital types was 7 days (range 1-178 days). Mean LOS was 1.2 days shorter at hospitals with thoracic surgery residencies versus hospitals without (p<0.001). At hospitals with thoracic surgery residencies, adjusted LOS was 1.3 days shorter after segmentectomy (p=0.009) and 0.9 days shorter after pneumonectomy (p=0.04), but not significantly shorter after lobectomy, when compared to hospitals without.
CONCLUSIONS:
Decreased LOS is typically associated with cost-savings and increased societal productivity due to resumption of work sooner, and has been proposed as a measure in performance improvement programs. LOS after segmentectomy and pneumonectomy is significantly decreased at hospitals with thoracic surgeons when compared to those with specialty-indeterminate surgeons. Our findings suggest that the observed differences are due to surgical specialty training, and that these procedures should be preferentially performed by thoracic surgeons. This is especially relevant given the societal trend towards less invasive procedures, such as segmentectomy.
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