General Thoracic Surgery Outcomes Are Not Improved in Hospitals Performing Cardiac Surgery: A Population-Based Analysis
Andrew Nguyen1, Mariam Selevany2, Amber L. Turner3, Joanna Sesti3, Russell Langan3, Subroto Paul3.
1RWJBarnabas Health, West Orange, NJ, USA, 2Newark Beth Israel Medical Center - RWJBarnabas Health, Newark, NJ, USA, 3Saint Barnabas Medical Center - RWJBarnabas Health, Livingston, NJ, USA.
OBJECTIVE: Limited data exists exploring whether multispecialty surgical collaboration is a predictor of outcomes in general thoracic surgery. To address this, the National Inpatient Sample (NIS) was analyzed to determine whether the presence of a cardiac surgery program is associated with improved general thoracic surgery outcomes.
METHODS: The NIS (1999-2008) was used to identify 389,959 patients who had a lobectomy, pneumonectomy, or esophagectomy procedure. In-hospital outcomes of patients undergoing these procedures were compared between hospitals with or without cardiac surgery programs. Univariate and multivariate analyses were performed to determine patient and hospital predictors of mortality and morbidity.
RESULTS: During the study period, patients undergoing lobectomy (n=314,130), pneumonectomy (n=34,860), or esophagectomy (n=40,969) were identified. Univariate analysis demonstrated lower mortality for lobectomy (p<0.001) and esophagectomy (p<0.001), but not for pneumonectomy (p<0.344) in hospitals with a cardiac surgery program. All-cause morbidity was significantly lower for all three procedures in hospitals with a cardiac surgery program. However, multivariate analysis demonstrated that a cardiac surgery program was not an independent predictor when adjusted for known confounders, particularly procedure volume and hospital academic teaching status.
CONCLUSIONS: Collaboration between general thoracic and cardiac surgery does not appear to independently improve lobectomy, pneumonectomy, or esophagectomy outcomes.
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