SPECIALISTS ACHIEVE BETTER OUTCOMES THAN GENERALISTS FOR LUNG-CANCER SURGERY

Objective: A push toward care provided by generalists as opposed to sp ecialists has occurred in the health-care marketplace despite a lack o f provider specific outcome data. The objective of this study was to d etermine whether the outcome of patients undergoing lung cancer surger y is different between general surgeons (GSs) and thoracic surgeons (T Ss). Design: Examination of data from a state-wide severity-adjusted a dministrative hospital discharge database. Setting/participants: Patie nts undergoing lung cancer resection in all nonfederal acute care hosp itals within South Carolina. Main outcome measures: Mortality by speci ality adjusted for case mix, Results: From 1991 to 1995, 1,720 resecti ons for lung cancer were performed in South Carolina. One hundred thir ty-seven cases were excluded because surgeons did not meet the predefi ned criteria for board certification, leaving 1,583 resections for ana lysis, One-half of lobectomies and nearly 60% of pneumonectomies mere performed by GSs, Patients were similar in age, sex, gender, race, and the proportion in each severity of illness subclass. Mortality was si gnificantly higher in patients who underwent lobectomy by GSs vs TSs ( 5.3% vs 3.0%; p < 0.05) and in patients with extreme comorbidities (43 .6% vs 25.4%; p = 0.03) or age >65 years (7.4% vs 3.5%; p < 0.05). Sev enty percent of TSs performed >10 cases in the series, whereas 75% of GSs performed < 10 (p = 0.05), Logistic regression analysis failed to identify any significant variable that might explain the mortality dif ferences between TSs and GSs, Conclusion: Mortality is lower for lung cancer resection when the surgery is performed by a TS.