STS: Lung Surgery Mortality Lower at Academic Centers

January 30, 2007

SAN DIEGO -- Academic medical centers, despite the training responsibilities that frighten many patients away, have lung cancer surgery outcomes that equal or exceed those of non-academic hospitals, researchers said here.

SAN DIEGO, Jan. 30 -- Academic medical centers, despite the training responsibilities that frighten many patients away, have lung cancer surgery outcomes that equal or exceed those of non-academic hospitals, researchers said here.

In a large, observational study, mortality rates following lung resection were actually superior at teaching hospitals, independent of case volume, reported Robert A. Meguid, M.D., of Johns Hopkins, and colleagues, at the Society of Thoracic Surgeons meeting.

In the study, a multivariate logistic regression analysis, controlling for confounders, including case-volume, found that undergoing a lobectomy at a academic medical center independently reduced the odds of mortality by 17% [OR(95%CI)=0.83(0.71-0.98), P=0.026] versus undergoing a lobectomy at a non-academic medical center. Overall mortality for pulmonary resections was significantly lower as well (P=0.016).

"We do find this a concern of our patients on a frequent basis; they are concerned about physicians in training practicing upon them," Dr. Meguid said, "but our studies show that they have no reason to be concerned based on outcomes."

However, the lower mortality rates found among patients at teaching hospitals do not suggest that doctors should preferentially send patients to these centers, Dr. Meguid said.

"This study is not intended to change practices and referral patterns, but just to reassure patients that should they go to academic hospitals they will not be receiving inferior care," he said.

The study included 50,867 lung resections in the Nationwide Inpatient Sample dataset from 1998 to 2003. The database encompassed 20% of hospitals in 37 states.

Patients were ages 18 to 85 (mean 64) and 46.3% were women. About half of the patients underwent their pulmonary resection for lung cancer at an academic medical center (55.2%). Most pulmonary resections were lobectomies (37,822) though there were also 8,144 segmentectomies and 4,901 pneumonectomies.

On multivariate analysis controlling for patient demographics, case-volume, and Charlson Index comorbidities, the findings were:

  • 3.82% overall mortality rate for pulmonary resections.
  • 3.63% mortality for pulmonary resections at academic centers versus 4.0% at non-teaching hospitals (P=0.016).
  • 2.94% mortality for lobectomies at academic centers versus 3.62% at non-academic centers (P