Do Individual Surgeon Volumes Affect Outcomes in Thoracic Surgery?

Saturday, October 12, 2019

Submitted by

Joel Dunning

Source

Source Name: European Journal of Cardio-Thoracic Surgery

Source URL: https://academic.oup.com/ejcts/article-abstract/56/4/770/5422982

Author(s)

Sebron Harrison, Tiany Sun, Mohamed K Kamel, Corbin Cleary, Brendon M Stiles, Nasser K Altorki, Art Sedrakyan

These incredible findings are the result of an analysis of the New York State Department of Health Statewide Planning and Research Cooperative database. They represent over 99,000 major lung resections from 1995 to 2014. Surgeons performing more than 30 lobectomies per year have a mortality of 1% and surgeons performing less than 12 per year have a mortality of 2.8%. But the most surprising fact is that the low-volume surgeons performed 90% of the lobectomies. Do you agree with the results of this very large study and if you do, what do you think should happen about this?

Comments

Submitted by Patrick McConnell on Mon, 2019-10-21 07:57

"Incredible" summary missing the racial and socio-demographic confounders completely. As their limitations section suggests, but does not fully embrace that they completely ignore the covariate of hospital volume - this data was available to them, but no analysis of the interaction of surgeon within hospital? Not that I'm paranoid, but why not include? Now if low volume surgeons within high volume centers are doing more medicaid/racially disadvantaged patients than their high volume SAS surgeons - then that is "incredibly" disappointing and further implicates the hospital culture as a root cause of mortality. So much more that could have been unpacked by this study - only if hospital volume was a covariate? That's more than likely why wedge resections showed the same surgeon volume bias. Database 'research' - the modern day alchemy: turning BS into plane tickets/hotel nights/promotion. My take away - sucks to be poor!