Cardiothoracic Surgery Board Review (Board Review in Cardiothoracic Surgery Book 1)

Cardiothoracic Surgery Board Review (Board Review in Cardiothoracic Surgery Book 1)

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Frigo ; Vladimiro L. Lung ultrasound profile after cardiopulmonary bypass in paediatric cardiac surgery: Minimally invasive endoscopic surgery versus catheter-based device occlusion for atrial septal defects in adults: The efficacy and risk of cerebrospinal fluid drainage for thoracoabdominal aortic aneurysm repair: Influence of warfarin therapy on the occurrence of postoperative endoleaks and aneurysm sac enlargement after endovascular abdominal aortic aneurysm repair Yoshimasa Seike ; Hiroshi Tanaka ; Tetsuya Fukuda ; Tatsuya Itonaga ; Yoshiaki Morita Systematic review on the predictive ability of frailty assessment measures in cardiac surgery Yusuf S.

Abdullahi ; Leonidas V.

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Athanasopoulos ; Roberto P. Casula ; Marco Moscarelli ; Mark Bagnall Does the addition of postoperative radiotherapy to adjuvant chemotherapy offer any benefit in patients with non-small cell lung cancer and mediastinal lymphadenopathy? Coil embolization of left ventricular outflow tract pseudoaneurysms: Surgical repair of ostial obstruction of the coronary artery for quadricuspid aortic valve in an infant Takeaki Harada ; Koji Fukae ; Yusuke Ando.

Posteromedial papillary muscle rupture due to squeezing of the left anterior descending coronary artery Kaoru Hattori ; Kozo Fukui ; Nobuaki Suzuki ; Kazuo Ito. A devilish dilemma Nelleke M. Korteland ; Johanna J. Takkenberg ; Ad J. While several different surgical subspecialists perform lung resection for cancer, many believe that this procedure is best performed by board-certified thoracic surgeons.

Using the national Medicare database to , we identified patients undergoing lung resection lobectomy or pneumonectomy for lung cancer.

Operating surgeons were identified by unique physician identifier codes contained in the discharge abstract. We used the American Board of Thoracic Surgery database, as well as physician practice patterns, to designate surgeons as general surgeons, cardiothoracic surgeons, or noncardiac thoracic surgeons.

Using logistic regression models, we compared operative mortality across surgeon subspecialties, adjusting for patient, surgeon, and hospital characteristics. Patient characteristics did not differ substantially by surgeon specialty. Adjusted operative mortality rates were lowest for cardiothoracic and noncardiac thoracic surgeons 7. Operative mortality with lung resection varies by surgeon specialty. Some, but not all, of this variation in operative mortality is attributable to hospital and surgeon volume. Many believe that subspecialty training may improve surgical outcomes in high-risk surgery.

Cardiothoracic Surgery Board Review (Board Review in Cardiothoracic Surgery Book 1)

Examples of this finding have been published across a wide range of surgical subspecialties. For example, in carotid endarterectomy, vascular surgeons were found to have lower in-hospital mortality and stroke rates than neurosurgeons or general surgeons. However, the impact of surgeon specialty on outcomes with lung cancer surgery is uncertain.

Surgeons that are board-certified in thoracic surgery have greater training in thoracic procedures than general surgeons. Moreover, some thoracic surgeons eschew cardiac procedures, focusing primarily on lung procedures. Although 1 study 7 has compared outcomes by specialty, this study was relatively small, restricted to 1 state, and was limited in examination of potentially confounding variables, such as hospital setting and hospital volume in lung resection.

Although many believe lung resection is best performed by board-certified thoracic surgeons, the empiric basis for this assumption has not been established. For this reason, we performed a national study comparing operative mortality rates with lung resection between noncardiac thoracic, cardiothoracic, and general surgeons.

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This file contains hospital discharge abstracts for acute care hospitalizations of all US Medicare recipients under the hospital Part A insurance program. We excluded patients under age 65 or over age Further details on the database are available elsewhere. We linked patients and surgeons using the unique provider identifier number in each patient record in the Medicare database. We then categorized surgeons into 3 distinct, mutually exclusive subspecialty categories: To ensure that we accurately designated thoracic surgeons, we obtained a list of board-certified thoracic surgeons from the American Board of Thoracic Surgery ABTS , the certifying body for thoracic surgeons.

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This list was merged with our Medicare file to identify thoracic surgeons. We further characterized thoracic surgeons as cardiothoracic surgeons or noncardiac thoracic surgeons. The former were defined as those performing at least 1 coronary artery bypass graft CABG procedure on any Medicare patient during the study period. Thoracic surgeons that did not perform any CABG procedures during the study period were designated as noncardiac thoracic surgeons.

Noncardiac thoracic and cardiothoracic surgeons were analyzed separately in the analysis. Determination of surgeon subspecialty. We used the patient as the unit of analysis. Our exposure variable was surgeon specialty general, cardiothoracic, or noncardiac thoracic , and our main outcome measure was operative mortality, defined as death before discharge or within 30 days of the operative procedure. Deaths occurring after discharge but within 30 days of the operative procedure were captured by using the National Death Index.

Utilizing methods previously described, 8,10 we used multiple logistic regression to study relationships between patient level variables and our main outcome measures. We adjusted for the following variables: Patient comorbidities were identified using information from both the index admission and admission occurring within the preceding 6 months.

Comorbidities were compiled into a Charlson score 11 for each patient, a commonly used measure of comorbidity status. The Charlson score weights patients based on the number and type of comorbidities recorded in the discharge abstract. Comorbidities typically include diagnoses such as chronic obstructive pulmonary disease, coronary artery disease, or hypertension.

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We also adjusted for the extent of resection lobectomy versus pneumonectomy. We also adjusted for characteristics of the hospital in which each surgeon practiced. For surgeons who operated in more than 1 hospital, we used the hospital in which he or she performed the most cases. Using the American Hospital Association file, we adjusted for the following variables: Given the well-documented association between operative mortality and hospital volume, 8,12,13 we also adjusted for hospital volume in lung resection. To eliminate any bias introduced by assignment of high- and low-volume cut points, hospital volume was considered as a continuous variable.

Given evidence 1,7,12,14 that operative mortality varies with surgeon experience, we adjusted for surgeon volume in lung resection, also considered as a continuous variable.

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In measuring hospital and surgeon volume, we defined volume as the total number of lung resections both Medicare and non-Medicare patients treated by the individual hospital or surgeon. Additionally, we adjusted for the effect of clustering 15 of patients within surgeons and within hospitals. Results from these regression models were used to generate adjusted mortality rates using predicted risk estimates. The institutional review board at Dartmouth Medical School approved our study protocol.

Overall, 25, patients were included in our analysis. The Thoracic and Cardiovascular Surgeon. I am a new personal subscriber and would like the special introductory rate for my first subscription year, if available. I am a current or former subscriber to this journal and would like to renew my subscription. For institutional subscriptions , please contact Institutional Sales for pricing at: In Europe, Asia, Africa and Australia, please contact eproducts thieme. Please read our complete Terms of Trade for journal subscription policies.

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