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J. Maxwell Chamberlain Memorial Paper for General Thoracic Surgery

Are Surgical Outcomes for Lung Cancer Resections Improved at Teaching Hospitals?

^a Division of Thoracic Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
^b Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
^c Virginia Cardiovascular and Thoracic Surgery Group, Mary Washington Hospital, Fredericksburg, Virginia

Accepted for publication September 4, 2007.

^_* Address correspondence to Dr Yang, Division of Thoracic Surgery, Department of Surgery, 600 N. Wolfe St., Blalock 240, The Johns Hopkins Hospital, Baltimore, MD 21287 (Email: syang{at}jhmi.edu).

Presented at the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007. Winner of the J. Maxwell Chamberlain Memorial Award for General Thoracic Surgery. Winner of the Thoracic Surgery Directors Association Resident Research Award.

Background: Defining centers of excellence for complex surgical procedures, including pulmonary resection, reveals lower mortality at high-volume centers. We postulate that short-term outcome after lung cancer resection is better at teaching hospitals (TH) compared with nonteaching hospitals (non-TH), independent of volume.

Methods: Lung cancer resections in the Nationwide Inpatient Sample (NIS) dataset from 1998 to 2004 were stratified by resection type (segmentectomy, lobectomy, and pneumonectomy). The TH identified in the NIS include those with Accreditation Council for Graduate Medical Education-approved general surgery (GSTH) and thoracic surgery (TSTH) residency programs. The association of hospital teaching status with in-hospital mortality was assessed by multivariate logistic regression, adjusting for patient demographics and comorbidities.

Results: Of 46,951 lung resections (5,651 segmentectomies, 37,027 lobectomies, 4,273 pneumonectomies), 56% were performed at TH. Overall mortality was significantly lower at TH versus non-TH (3.2% vs 4.0%; p < 0.001). Subgroup analysis for GSTH and TSTH confirmed this decrease. On multivariate regression, overall odds of death was independently reduced by 17% at TH versus non-TH (95% confidence interval: 0.73 to 0.93; p = 0.002). At TH, odds of death for pneumonectomy and lobectomy were significantly reduced independent of surgical volume, except for the latter at the highest hospital volume strata.

Conclusions: In-hospital mortality is reduced for patients undergoing lung cancer resections at teaching hospitals, with results prominent at all but the highest volume institutions. Lower mortality rates persisted at GSTH and TSTH. Understanding and disseminating the processes of care associated with these settings may improve quality of care for lung cancer patients, and decrease patient bias against teaching hospitals.