Specialists Achieve Better Outcomes Than Generalists for Lung Cancer Surgery

¹ From the Department of Medicine, The Center for Health Care Research, and the Hollings Cancer Center, at the Medical University of South Carolina, Charleston
² From the Department of Surgery, at the Medical University of South Carolina, Charleston
³ From the Departments of Biometry and Epidemiology, at the Medical University of South Carolina, Charleston
⁴ From the South Carolina Office of Research and Statistics, Columbia
⁵ From the Department of Surgery, and the Hollings Cancer Center, at the Medical University of South Carolina, Charleston

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.

Key Words: generalist • lobectomy • lung cancer • outcomes • pneumonectomy • specialist • surgery

Submitted on October 14, 1997
Accepted on January 13, 1998

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