D. J. Gross1, P. L. Rosen1, V. Roudnitsky4, M. Muthusamy3, G. Sugiyama2, P. J. Chung3 2Hofstra Northwell School Of Medicine,Department Of Surgery,Hempstead, NEW YORK, USA 3Coney Island Hospital,Department Of Surgery,Brooklyn, NY, USA 4Kings County Hospital Center,Department Of Surgery, Division Of Acute Care Surgery And Trauma,Brooklyn, NY, USA 1SUNY Downstate,Department Of Surgery,Brooklyn, NY, USA
Introduction: The number of thoracic resections performed for lung cancer is expected to rise due to increased screening in high risk populations. However majority of thoracic surgical procedures in the US are performed by general surgeons (GS). Currently Video Assisted Thoracoscopic Surgery (VATS) has become the preferred approach to lung resection when feasible. Our goal is to examine short term outcomes of VATS lobectomy for malignancy performed by either GS or CT surgeons using the America College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) database.
Methods: Using ACS NSQIP 2010-2015 we identified patients that had an ICD 9 diagnosis of lung cancer (162) that underwent VATS lobectomy (CPT 32663). We included only adults (≥18 years) and elective cases and excluded cases that had preoperative sepsis, contaminated/dirty wound class, and missing data. Risk variables of interest included demographic, comorbidity, and perioperative variables. Outcomes of interest included 30-day postoperative mortality, 30-day postoperative morbidity, and length of stay (LOS). Univariate analysis comparing cases performed by GS vs CT was performed. We then performed propensity score analysis using a 3:1 ratio of CT:GS cases with categorical outcome variables assessed using conditional logistic regression.
Results: A total of 4,308 cases met criteria; 649 (15.1%) by GS and 3,659 (84.9%) by CT. Mean age in the GS group was 68.6 vs 67.8 years in the CT group (p=0.034). There was a greater proportion of African American patients in the GS compared to CT group (8.0% vs 3.4%, p<0.0001), but higher rates of dyspnea with moderate exertion in the CT compared to GS group (19.8% vs 12.9%, p<0.0001). Operative time was shorter in the GS group vs CT group (179 vs 196 minutes, p <0.0001). After propensity score matching the two groups were found to be well balanced on all risk variables. LOS was longer in the GS vs matching CT group (mean 6.2 vs 5.3 days, p=0.0001). Conditional logistic regression showed that GS treated patients had no greater risk of 30-day mortality (p=0.806), but had greater risk of postoperative sepsis (OR 2.20, 95% CI [1.01, 4.79], p=0.047).
Conclusion: In this large observational study using a prospectively collected clinical database, we found that while general surgeons had longer LOS, compared to cardiothoracic trained surgeons there were no differences in short-term mortality and morbidity with the exception of increased risk of postoperative sepsis. Further prospective studies are warranted to investigate oncologic and long-term outcomes.