A comparison of quality and cost indicators by surgical specialty for lobectomy of the lung

J Thorac Cardiovasc Surg. 2013 Jan;145(1):68-73; discussion 73-4. doi: 10.1016/j.jtcvs.2012.09.012. Epub 2012 Oct 8.

Abstract

Objectives: This investigation compared patients undergoing lobectomy for non-small cell lung cancer by either a general surgeon or a cardiothoracic surgeon across a geographically diverse system of hospitals to see whether a significant difference in quality or cost was present.

Methods: The Premiere administrative database and tumor registry data of a single health system's hospitals was used to compare adherence to national treatment guidelines, patient outcomes, and charges for patients undergoing lobectomy for non-small cell lung cancer in a 5-year period. Surgeons performing lobectomy were designated as a general surgeon or cardiothoracic surgeon according to their national provider number and board certification status. Excluded from analysis were centers that performed fewer than 50 lobectomies during the study period.

Results: During the study period, 2823 lobectomies were performed by 46 general surgeons and 3653 lobectomies were performed by 29 cardiothoracic surgeons in 54 hospitals in a single health care system. Significant differences were found between general and cardiothoracic surgeons with respect to adherence to national guidelines in staging and treatment, mean length of stay, significant morbidity, and operative mortality. Mean charges for lobectomy of the lung were also found to differ significantly between general and cardiothoracic surgeons.

Conclusions: This review found that currently measurable indicators for quality of care were significantly superior and overall charges were significantly reduced when a lobectomy for non-small cell lung cancer was performed by a cardiothoracic surgeon rather than by a general surgeon.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Carcinoma, Non-Small-Cell Lung / mortality
  • Carcinoma, Non-Small-Cell Lung / surgery*
  • Education, Medical, Graduate
  • Female
  • General Surgery* / economics
  • General Surgery* / education
  • General Surgery* / standards
  • Guideline Adherence
  • Hospital Costs*
  • Hospital Mortality
  • Humans
  • Logistic Models
  • Lung Neoplasms / mortality
  • Lung Neoplasms / surgery*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Outcome and Process Assessment, Health Care* / economics
  • Outcome and Process Assessment, Health Care* / standards
  • Pneumonectomy* / adverse effects
  • Pneumonectomy* / economics
  • Pneumonectomy* / education
  • Pneumonectomy* / mortality
  • Pneumonectomy* / standards
  • Postoperative Complications / economics
  • Postoperative Complications / mortality
  • Postoperative Complications / therapy
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'
  • Quality Indicators, Health Care* / economics
  • Quality Indicators, Health Care* / standards
  • Registries
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Thoracic Surgery* / economics
  • Thoracic Surgery* / education
  • Thoracic Surgery* / standards
  • Treatment Outcome
  • United States