Hospitals Teaching CT Surgery Excel At Lung Resection

SAN FRANCISCO - Pulmonary resection outcomes vary with respect to the kind of hospital in which the procedure is performed, particularly whether it is a teaching hospital, according to Dr. Castigliano M. Bhamidipati, of the University of Virginia Medical School, Charlottesville.

"In comparison to other hospitals, including general surgery teaching hospitals, cardiothoracic surgery teaching hospitals have lower morbidity and mortality," Dr. Bhamidipati said at the AATS annual meeting.

He and his colleagues examined the results of pulmonary resections performed at cardiothoracic (CT) teaching, general surgery (GS) teaching, nonsurgical (NS) teaching, and nonteaching (NT) hospitals.

The researchers evaluated the discharge records of nearly 500,000 adults who underwent either pneumonectomy, segmentectomy, lobar resections, or nonanatomic resections in an all-payer inpatient database for the time period between 2003 and 2009, according to Dr. Bhamidipati.

The hospital's teaching status as used in the study was determined by a linkage to the Association of American Medical Colleges’ Graduate Medical Education Tracking System.

The researchers examined patient demographics, risk factors, and hospital characteristics, and used multiple logistic regression models to examine in-hospital mortality, occurrence of any complications, and failure to rescue (death following a complication).

The mean annual percent of pulmonary resection volume among hospitals was CT (16%), GS (17%), NS (28%), and NT (39%).

The average age of pulmonary resection recipients among hospitals was similar, as were their mean number of comorbidities. The CT hospitals treated the smallest number of Medicare patients and the highest number of patients with Medicaid, a significant difference, said Dr. Bhamidipati.

He reported that the unadjusted mortality for all procedures was significantly lowest at the CT hospitals (CT: 2.6%; GS: 2.8%; NS: 3.4%; NT 3.6%).

Similarly, any complication was also least likely to occur at a CT hospital (CT: 20.5%, GS: 23.5%, NS: 24.6%, NT: 24.9%), he added.

Unadjusted procedural complications were found to be similar across hospitals, although pulmonary complications were significantly less likely to occur at CT hospitals compared with the others, according to Dr. Bhamidipati.

Following case-mix adjustment, the risk of having any complication after segmentectomy or nonanatomic resection was found to be significantly lower at CT hospitals than at the GS hospitals, he said.

In addition, among the pneumonectomy recipients, CT teaching status independently and significantly reduced the adjusted odds ratio (AOR) of failure to rescue by more than 25% compared with NS (AOR 0.34 vs. AOR 0.62).

Similarly, for the pneumonectomy patients, performance of the surgery at CT centers significantly lowered the AOR of death by more than 30% compared with GS hospitals (AOR 0.33 vs. AOR 0.69).

"These results support using CT hospital teaching status as an independent prognosticator of outcomes in pulmonary resections," concluded Dr. Bhamidipati.

Dr. Bhamidipati reported that he and his colleagues had no relevant disclosures.

SAN FRANCISCO - Pulmonary resection outcomes vary with respect to the kind of hospital in which the procedure is performed, particularly whether it is a teaching hospital, according to Dr. Castigliano M. Bhamidipati, of the University of Virginia Medical School, Charlottesville.

"In comparison to other hospitals, including general surgery teaching hospitals, cardiothoracic surgery teaching hospitals have lower morbidity and mortality," Dr. Bhamidipati said at the AATS annual meeting.

He and his colleagues examined the results of pulmonary resections performed at cardiothoracic (CT) teaching, general surgery (GS) teaching, nonsurgical (NS) teaching, and nonteaching (NT) hospitals.

The researchers evaluated the discharge records of nearly 500,000 adults who underwent either pneumonectomy, segmentectomy, lobar resections, or nonanatomic resections in an all-payer inpatient database for the time period between 2003 and 2009, according to Dr. Bhamidipati.

The hospital's teaching status as used in the study was determined by a linkage to the Association of American Medical Colleges’ Graduate Medical Education Tracking System.

The researchers examined patient demographics, risk factors, and hospital characteristics, and used multiple logistic regression models to examine in-hospital mortality, occurrence of any complications, and failure to rescue (death following a complication).

The mean annual percent of pulmonary resection volume among hospitals was CT (16%), GS (17%), NS (28%), and NT (39%).

The average age of pulmonary resection recipients among hospitals was similar, as were their mean number of comorbidities. The CT hospitals treated the smallest number of Medicare patients and the highest number of patients with Medicaid, a significant difference, said Dr. Bhamidipati.

He reported that the unadjusted mortality for all procedures was significantly lowest at the CT hospitals (CT: 2.6%; GS: 2.8%; NS: 3.4%; NT 3.6%).

Similarly, any complication was also least likely to occur at a CT hospital (CT: 20.5%, GS: 23.5%, NS: 24.6%, NT: 24.9%), he added.

Unadjusted procedural complications were found to be similar across hospitals, although pulmonary complications were significantly less likely to occur at CT hospitals compared with the others, according to Dr. Bhamidipati.

Following case-mix adjustment, the risk of having any complication after segmentectomy or nonanatomic resection was found to be significantly lower at CT hospitals than at the GS hospitals, he said.

In addition, among the pneumonectomy recipients, CT teaching status independently and significantly reduced the adjusted odds ratio (AOR) of failure to rescue by more than 25% compared with NS (AOR 0.34 vs. AOR 0.62).

Similarly, for the pneumonectomy patients, performance of the surgery at CT centers significantly lowered the AOR of death by more than 30% compared with GS hospitals (AOR 0.33 vs. AOR 0.69).

"These results support using CT hospital teaching status as an independent prognosticator of outcomes in pulmonary resections," concluded Dr. Bhamidipati.

Dr. Bhamidipati reported that he and his colleagues had no relevant disclosures.

SAN FRANCISCO - Pulmonary resection outcomes vary with respect to the kind of hospital in which the procedure is performed, particularly whether it is a teaching hospital, according to Dr. Castigliano M. Bhamidipati, of the University of Virginia Medical School, Charlottesville.

"In comparison to other hospitals, including general surgery teaching hospitals, cardiothoracic surgery teaching hospitals have lower morbidity and mortality," Dr. Bhamidipati said at the AATS annual meeting.

He and his colleagues examined the results of pulmonary resections performed at cardiothoracic (CT) teaching, general surgery (GS) teaching, nonsurgical (NS) teaching, and nonteaching (NT) hospitals.

The researchers evaluated the discharge records of nearly 500,000 adults who underwent either pneumonectomy, segmentectomy, lobar resections, or nonanatomic resections in an all-payer inpatient database for the time period between 2003 and 2009, according to Dr. Bhamidipati.

The hospital's teaching status as used in the study was determined by a linkage to the Association of American Medical Colleges’ Graduate Medical Education Tracking System.

The researchers examined patient demographics, risk factors, and hospital characteristics, and used multiple logistic regression models to examine in-hospital mortality, occurrence of any complications, and failure to rescue (death following a complication).

The mean annual percent of pulmonary resection volume among hospitals was CT (16%), GS (17%), NS (28%), and NT (39%).

The average age of pulmonary resection recipients among hospitals was similar, as were their mean number of comorbidities. The CT hospitals treated the smallest number of Medicare patients and the highest number of patients with Medicaid, a significant difference, said Dr. Bhamidipati.

He reported that the unadjusted mortality for all procedures was significantly lowest at the CT hospitals (CT: 2.6%; GS: 2.8%; NS: 3.4%; NT 3.6%).

Similarly, any complication was also least likely to occur at a CT hospital (CT: 20.5%, GS: 23.5%, NS: 24.6%, NT: 24.9%), he added.

Unadjusted procedural complications were found to be similar across hospitals, although pulmonary complications were significantly less likely to occur at CT hospitals compared with the others, according to Dr. Bhamidipati.

Following case-mix adjustment, the risk of having any complication after segmentectomy or nonanatomic resection was found to be significantly lower at CT hospitals than at the GS hospitals, he said.

In addition, among the pneumonectomy recipients, CT teaching status independently and significantly reduced the adjusted odds ratio (AOR) of failure to rescue by more than 25% compared with NS (AOR 0.34 vs. AOR 0.62).

Similarly, for the pneumonectomy patients, performance of the surgery at CT centers significantly lowered the AOR of death by more than 30% compared with GS hospitals (AOR 0.33 vs. AOR 0.69).

"These results support using CT hospital teaching status as an independent prognosticator of outcomes in pulmonary resections," concluded Dr. Bhamidipati.

Dr. Bhamidipati reported that he and his colleagues had no relevant disclosures.