Surgery News- July 2008

14 THORACIC SURGERY NEWS • J U LY 2 0 0 8 Thoracic Teaching Hospitals Best for Esophagectomy BY DOUG BRUNK Else vier Global Medical Ne ws S A N D I E G O — In-hospital mortality is significantly reduced for patients undergoing esophagectomy for cancer at teaching hospitals with thoracic surgery and/or general surgery residency programs, results from a large analysis demonstrated. However, the greatest reduction in the risk of death occurred at hospitals with thoracic surgery residency programs compared with those that have general surgery residency programs only, Dr. Robert A. Meguid reported at the annual meeting of the American Association for Thoracic Surgery. “Performing esophageal resections at hospitals with thoracic surgery training programs provides a source of mortality improvement, independent of hospital volume,” said Dr. Meguid of the division of thoracic surgery at Johns Hopkins Medical Institutions, Baltimore. “Research should be focused on identifying other and more specific processes of care which may improve patient outcomes.” He and his associates used the Nationwide Inpatient Sample of 1998-2005 to identify 4,080 patients who underwent esophagectomy for cancer at 1,508 different hospitals. Hospital teaching status was determined by NIS data and by data from the Accreditation Council for Graduate Medical Education. They used multivariate logistic regression to assess the link between hospital teaching status and postoperative in-hospital mortality, adjusting for demographics and comorbidities. New from the American College of Surgeons and Thomson Healthcare I Need an Operation Now What? A Patient’s Guide to a Safe and Successful Outcome I Need an Operation…Now What? gives patients the information they need to boost their chances of having a successful surgical experience, with the best possible results. Written in patient-friendly, nontechnical language, this book is designed to help patients understand the process of having an operation from start to finish. Inside they’ll learn: » How to find a qualified surgeon—one who’s right for them » When to get a second opinion about their treatment—and how to go about finding one » How to ask about the risks and benefits of having an operation » How to prepare for an operation—from what to pack and what to wear to when to stop eating » What to expect, including advice from patients who’ve had various operations, from major gastrointestinal procedures to back surgery—and who will care for them—while in the hospital » Numerous "insider's" tips, such as how to help prevent infection and the best times to schedule an operation » All the costs of the operation » How to ensure a comfortable recovery period The experts agree “Along with your love and support, the greatest gift you can give a loved one or friend facing or weighing the beneﬁts and risks of surgery is a copy of this book. With his thoughtful, clear, very accessible writing, Dr. Russell, with the American College of Surgeons, provides a wealth of informational resources that every patient can draw on. He gives excellent advice on how to ask good questions and become an informed, empowered consumer. Most importantly, he urges you, the patient, to ‘take control and become fully informed about your options.’ This book will help you do that, prepare you for the effects of surgery and how to deal with them and give you conﬁdence as you navigate through the health care system.” Helen Darling, president of the ISBN 13: 978156363-700-1 Pub. Jan 2008 • Paperback $19.95 • 125 pp National Business Group on Health “Like a true professional, Dr. Russell gives surgical patients-to-be all the information and support needed to make decisions that meet their needs as only they can know them. This book is not only practical, but also highly respectful, most educational. Patients can use this book to navigate through their surgical experience while we all push for a better-organized health care delivery system.” Richard J. Umbdenstock, president and CEO of the American Hospital Association Of the 4,080 patients 2,883 were treated at teaching hospitals while 1,197 were treated at nonteaching hospitals. The median age of patients was 65 years and the majority (80%) were male. The median Charleston Index score of patients was 3 and the median length of stay was 13 days. The median annual hospital volume was significantly higher at teaching vs. nonteaching hospitals (6 vs. 2, respectively) but the mortality rate was significantly lower at teaching hospitals (9% vs. 12%, respectively). Dr. Meguid also reported that the median annual hospital volume was significantly higher at hospitals with thoracic surgery residency programs compared with hospitals that lacked thoracic surgery residency programs (13 vs. 3, respectively) but the mortality rate was significantly lower at hospitals with thoracic surgery residency programs (6% vs. 11%, respectively). Multivariate regression analysis revealed that the overall risk of postoperative death was reduced by 30% at teaching vs. nonteaching hospitals (OR 0.70). With the addition of hospital esophagectomy volume to the analysis, the reduction in death persisted (13%, or an OR of 0.87), but effect of teaching hospital status was attenuated and lost statistical significance. Multivariate regression analysis also revealed that the overall risk of postoperative death was reduced by 43% at hospitals with general surgery residency programs compared with hospitals that had no surgery residency programs. With the addition of hospital esophagectomy volume to the analysis, the reduction in death diminished slightly but remained statistically significant (a reduction of 30%). In the final multivariate regression analysis, the researchers found that the overall risk of postoperative death was reduced by 48% at hospitals with thoracic surgery residency programs compared with those lacking thoracic surgery residency programs. With the addition of hospital esophagectomy volume to the analysis the reduction in death diminished minimally and approached statistical significance (a reduction of 36%). “As the specificity of hospitals with thoracic surgeons increased, the odds of postoperative death decreased,” Dr. Meguid said. Dr. Meguid noted that in 2008 it is estimated that there will be more than 16,400 new cases of esophageal cancer in the United States and more than 14,200 deaths from the disease. He had no conflicts of interest to disclose. ■ “Research shows that people who are well informed about their treatment options enjoy better surgical outcomes and are more satisfied with their results.” INDEX OF ADVERTISERS ETHICON, Inc. Ligamax General Scientific Corporation SurgiTel Surgi-Cam 16 5 11 7 To order or for further information visit http://www.facs.org/public_info/patientguidebook.html or call 312/202-5474 KCI InfoV.A.C. Nashville Surgical Instruments Kumar PRE-VIEW http://www.facs.org/public_info/patientguidebook.html

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Surgery News- July 2008 Contents The 20/20 Vision: Health Reform Trauma: Airway Anchor News From the College: Jacobson Winner General Surgery: Worth the Trouble

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