Impact of Surgeon Specialty on Perioperative Outcomes of Surgery for Benign Esophageal Diseases: A NSQIP Analysis

J Laparoendosc Adv Surg Tech A. 2017 Sep;27(9):924-930. doi: 10.1089/lap.2017.0083. Epub 2017 Jun 8.

Abstract

Background: Surgery for benign esophageal disease is mostly performed either by general surgeons (GS) or cardiothoracic surgeons (CTS) in the United States. The purpose of this study was to evaluate the effect of surgeon specialty on perioperative outcomes of surgery for benign esophageal diseases.

Materials and methods: We have conducted a retrospective analysis using the ACS-NSQIP during the period of 2006-2013. Patients who underwent paraesophageal hernia (PEH) repair, gastric fundoplication, or Heller esophagomyotomy were divided into two groups according to the specialty of the surgeon (GS or CTS). Outcomes compared between the two groups using multivariable logistic regression included 30-day mortality, overall morbidity, discharge destination, hospital length of stay (LOS), and readmission rates.

Results: Most of the surgeries were performed by general surgeons (PEH: 97.1%; fundoplication: 97.6%; Heller: 91.6%). Patients had lower comorbidities, better physical condition, and underwent a laparoscopic approach more frequently in the GS group. Regression analysis showed that GS group had a lower mortality rate (operating room, 0.44; 95% confidence interval [CI]: 0.23-0.86; P = .017), shorter LOS, and more home discharge for patients undergoing PEH repair. Mortality, morbidity, readmission, LOS, and home discharge were comparable between GS and CTS in fundoplication and Heller esophagomyotomy.

Conclusion: GS perform most of esophageal surgeries for benign diseases. GS group has better outcomes in PEH repair compared with CTS, whereas there is no difference in the overall outcomes between GS and CTS in fundoplication and Heller esophagomyotomy. These results show that specialization is not always the answer to better outcomes. Difference in outcomes, however, might be related to disease severity, approach needed, or case volume.

Keywords: benign disease; esophageal surgery; outcomes.

MeSH terms

  • Adult
  • Aged
  • Esophageal Diseases / surgery*
  • Esophagectomy / standards*
  • Female
  • Fundoplication / methods
  • Gastric Fundus / surgery
  • General Surgery / statistics & numerical data*
  • Hernia, Hiatal / surgery
  • Hospital Mortality
  • Humans
  • Length of Stay
  • Logistic Models
  • Male
  • Middle Aged
  • Retrospective Studies
  • Specialization / statistics & numerical data*
  • Thoracic Surgery / statistics & numerical data*
  • United States