Mark S. Lesney

In cases of blunt thoracoabdominal trauma, the abdomen should be the initial cavity of exploration in patients requiring emergent surgery without direct radiologic data, based on the results of a trauma registry and medical record review of 1,661 patients.

Abdominal exploration first is justified because rarely are nonresuscitative thoracotomy or combined thoracoabdominal operations needed, researchers stated in the June issue of Archives of Surgery.

"To our knowledge, the current study is the most complete examination of injury patterns and outcomes in the largest series of blunt thoracoabdominal trauma patients to date," wrote study investigators Dr. Regan J. Berg and colleagues in the division of trauma surgery and surgical critical care, Los Angeles County + University of Southern California Medical Center in Los Angeles.

The researchers retrospectively studied all patients with blunt thoracoabdominal trauma (defined as an Abbreviated Injury Score of 2 or more in both the chest and abdomen) who were admitted to the LAC+USC Medical Center between January 1996 and December 2010. They examined a trauma registry and obtained additional data from the review of individual medical records.

A total of 1,667 patients fulfilled the inclusion criteria, but 6 were excluded for incomplete medical data. The most frequent causes of injury in the remaining 1,661 patients were motor vehicle collision (68.1%), falls (15.6%), and motorcycle collisions (10.4%), with assault accounting for only 1.8% of patients (Arch. Surg. 2012;147:498-504).

Most patients with isolated thoracoabdominal trauma arriving alive and without severe head trauma (821/1,135 patients, or 72.3%) were managed conservatively, without thoracotomy or laparotomy. Only 9/1,135 patients (0.8%) required a thoracotomy alone. Of those, three had the thoracotomy in the operating room, and six patients had resuscitative therapy (RT) performed outside the operating room for postadmission cardiac arrest or hemodynamic deterioration, according to the researchers.

Laparotomy alone was required in 281 (24.8%), while only 24 patients (2.1%) had both a laparotomy and a thoracotomy; 7 patients (0.6%) had a laparotomy following RT.

Independent risk factors of mortality included an Injury Severity Score of 25 or more, a Glasgow Coma Scale score of 8 or less, the need for massive transfusions, age of 55 years or older, and the need for dual-cavity intervention. Among injury patterns, liver, abdominal vascular, and cardiac injury were independently associated with mortality, they added.

"Most thoracic procedures were performed for resuscitative purposes with low survival rates, in keeping with previous literature. Furthermore, concomitant thoracic injury did not preclude nonoperative management of abdominal solid organ injury, with a degree of success comparable with previous reports," the researchers concluded.

The authors reported that they had no relevant financial disclosures.

In cases of blunt thoracoabdominal trauma, the abdomen should be the initial cavity of exploration in patients requiring emergent surgery without direct radiologic data, based on the results of a trauma registry and medical record review of 1,661 patients.

Abdominal exploration first is justified because rarely are nonresuscitative thoracotomy or combined thoracoabdominal operations needed, researchers stated in the June issue of Archives of Surgery.

"To our knowledge, the current study is the most complete examination of injury patterns and outcomes in the largest series of blunt thoracoabdominal trauma patients to date," wrote study investigators Dr. Regan J. Berg and colleagues in the division of trauma surgery and surgical critical care, Los Angeles County + University of Southern California Medical Center in Los Angeles.

The researchers retrospectively studied all patients with blunt thoracoabdominal trauma (defined as an Abbreviated Injury Score of 2 or more in both the chest and abdomen) who were admitted to the LAC+USC Medical Center between January 1996 and December 2010. They examined a trauma registry and obtained additional data from the review of individual medical records.

A total of 1,667 patients fulfilled the inclusion criteria, but 6 were excluded for incomplete medical data. The most frequent causes of injury in the remaining 1,661 patients were motor vehicle collision (68.1%), falls (15.6%), and motorcycle collisions (10.4%), with assault accounting for only 1.8% of patients (Arch. Surg. 2012;147:498-504).

Most patients with isolated thoracoabdominal trauma arriving alive and without severe head trauma (821/1,135 patients, or 72.3%) were managed conservatively, without thoracotomy or laparotomy. Only 9/1,135 patients (0.8%) required a thoracotomy alone. Of those, three had the thoracotomy in the operating room, and six patients had resuscitative therapy (RT) performed outside the operating room for postadmission cardiac arrest or hemodynamic deterioration, according to the researchers.

Laparotomy alone was required in 281 (24.8%), while only 24 patients (2.1%) had both a laparotomy and a thoracotomy; 7 patients (0.6%) had a laparotomy following RT.

Independent risk factors of mortality included an Injury Severity Score of 25 or more, a Glasgow Coma Scale score of 8 or less, the need for massive transfusions, age of 55 years or older, and the need for dual-cavity intervention. Among injury patterns, liver, abdominal vascular, and cardiac injury were independently associated with mortality, they added.

"Most thoracic procedures were performed for resuscitative purposes with low survival rates, in keeping with previous literature. Furthermore, concomitant thoracic injury did not preclude nonoperative management of abdominal solid organ injury, with a degree of success comparable with previous reports," the researchers concluded.

The authors reported that they had no relevant financial disclosures.

In cases of blunt thoracoabdominal trauma, the abdomen should be the initial cavity of exploration in patients requiring emergent surgery without direct radiologic data, based on the results of a trauma registry and medical record review of 1,661 patients.

Abdominal exploration first is justified because rarely are nonresuscitative thoracotomy or combined thoracoabdominal operations needed, researchers stated in the June issue of Archives of Surgery.

"To our knowledge, the current study is the most complete examination of injury patterns and outcomes in the largest series of blunt thoracoabdominal trauma patients to date," wrote study investigators Dr. Regan J. Berg and colleagues in the division of trauma surgery and surgical critical care, Los Angeles County + University of Southern California Medical Center in Los Angeles.

The researchers retrospectively studied all patients with blunt thoracoabdominal trauma (defined as an Abbreviated Injury Score of 2 or more in both the chest and abdomen) who were admitted to the LAC+USC Medical Center between January 1996 and December 2010. They examined a trauma registry and obtained additional data from the review of individual medical records.

A total of 1,667 patients fulfilled the inclusion criteria, but 6 were excluded for incomplete medical data. The most frequent causes of injury in the remaining 1,661 patients were motor vehicle collision (68.1%), falls (15.6%), and motorcycle collisions (10.4%), with assault accounting for only 1.8% of patients (Arch. Surg. 2012;147:498-504).

Most patients with isolated thoracoabdominal trauma arriving alive and without severe head trauma (821/1,135 patients, or 72.3%) were managed conservatively, without thoracotomy or laparotomy. Only 9/1,135 patients (0.8%) required a thoracotomy alone. Of those, three had the thoracotomy in the operating room, and six patients had resuscitative therapy (RT) performed outside the operating room for postadmission cardiac arrest or hemodynamic deterioration, according to the researchers.

Laparotomy alone was required in 281 (24.8%), while only 24 patients (2.1%) had both a laparotomy and a thoracotomy; 7 patients (0.6%) had a laparotomy following RT.

Independent risk factors of mortality included an Injury Severity Score of 25 or more, a Glasgow Coma Scale score of 8 or less, the need for massive transfusions, age of 55 years or older, and the need for dual-cavity intervention. Among injury patterns, liver, abdominal vascular, and cardiac injury were independently associated with mortality, they added.

"Most thoracic procedures were performed for resuscitative purposes with low survival rates, in keeping with previous literature. Furthermore, concomitant thoracic injury did not preclude nonoperative management of abdominal solid organ injury, with a degree of success comparable with previous reports," the researchers concluded.

The authors reported that they had no relevant financial disclosures.

Surgeons are more reluctant to withdraw life support if they made an error during surgery. This is especially true after an elective procedure, according to an extended analysis of a recent scenario-based survey of 2,100 surgeons who were involved in high-risk operations.

The survey included a series of questions regarding specialty-specific scenarios for 700 vascular surgeons (elective and emergent thoracoabdominal aortic aneurysm repair), 700 cardiothoracic surgeons (elective and emergent ascending aortic aneurysm repair), and 700 neurosurgeons (elective and emergent calcified right middle cerebral artery aneurysm clipping), according to Dr. Margaret L. Schwarze of the University of Wisconsin, Madison, and colleagues.

In the case of the vascular and the cardiac surgeons, the complication was the same: The "patient has weakness in left arm and leg when she awakes from anesthesia." The surgical error for the vascular surgeons was inadvertent placement of the proximal clamp so that it occluded the left carotid artery; for the cardiac surgeons, it was inadvertent dislodging of the arterial cannula. For both vascular and cardiac procedures, the non–error-caused complication resulted from unexplained intraoperative stroke.

The three specialties were chosen based on the presumption of routine high-risk operations, according to a report published online ahead of print in the Annals of Surgery (2012;256:10-15).

This analysis follows an earlier report in the Annals of Surgery by these same authors, who used these same survey data to determine that the majority of these surgeons performing high-risk operations did not discuss advanced directives with their patients, and 54% were unlikely to operate on these patients if they were aware of such directives prior to surgery (Ann. Surg. 2012;255:418-23).

Of the original 2,100 surveys that were sent out, 912 were completed and returned, with roughly equal percentages (54%-56%) for each specialty.

Multivariate analysis showed that surgeons who faced complications after emergency surgery that were not clearly the result of surgeon error were nearly twice as likely to agree to withdraw life-sustaining support, compared with surgeons evaluating elective procedures that had a complication resulting from surgeon error (odds ratio, 1.95). In addition, the odds of withdrawing life support were significantly greater among surgeons who were not optimistic about the patient’s future quality of life (OR, 1.75) and among those who were not concerned that the patients did not accurately value their future health state (OR, 1.59), compared with their counterparts, according to the authors.

"Iatrogenic complications that clearly derive from technical errors during elective procedures may pose considerable guilt and emotional burden upon surgeons," the authors speculated. "It is understandable that such factors should weigh on the surgeon. However, our findings call into question the degree to which these factors may unduly interfere with a patient’s ability to control his or her health care decisions."

In addition, "our data suggest that the commission of an error in surgical technique and prognostic optimism may present a challenge to patient autonomy. ... [This] suggests the importance of efforts to alleviate surgeons’ emotional strain while simultaneously respecting the fierce ethic of responsibility that surgeons possess for patients’ outcomes."

When a patient experiences a life-threatening complication and requests withdrawal of life-supporting therapy postoperatively, surgeons may be unlikely to do so without delay, according to the authors. "These decisions may be influenced by both the timing of surgery and whether the complication was the result of explicit technical error. In addition, these nonclinical factors may be associated with surgeons’ optimism about the patient’s postoperative quality of life," they concluded.

The authors reported that they had no financial disclosures.

Surgeons are more reluctant to withdraw life support if they made an error during surgery. This is especially true after an elective procedure, according to an extended analysis of a recent scenario-based survey of 2,100 surgeons who were involved in high-risk operations.

The survey included a series of questions regarding specialty-specific scenarios for 700 vascular surgeons (elective and emergent thoracoabdominal aortic aneurysm repair), 700 cardiothoracic surgeons (elective and emergent ascending aortic aneurysm repair), and 700 neurosurgeons (elective and emergent calcified right middle cerebral artery aneurysm clipping), according to Dr. Margaret L. Schwarze of the University of Wisconsin, Madison, and colleagues.

In the case of the vascular and the cardiac surgeons, the complication was the same: The "patient has weakness in left arm and leg when she awakes from anesthesia." The surgical error for the vascular surgeons was inadvertent placement of the proximal clamp so that it occluded the left carotid artery; for the cardiac surgeons, it was inadvertent dislodging of the arterial cannula. For both vascular and cardiac procedures, the non–error-caused complication resulted from unexplained intraoperative stroke.

The three specialties were chosen based on the presumption of routine high-risk operations, according to a report published online ahead of print in the Annals of Surgery (2012;256:10-15).

This analysis follows an earlier report in the Annals of Surgery by these same authors, who used these same survey data to determine that the majority of these surgeons performing high-risk operations did not discuss advanced directives with their patients, and 54% were unlikely to operate on these patients if they were aware of such directives prior to surgery (Ann. Surg. 2012;255:418-23).

Of the original 2,100 surveys that were sent out, 912 were completed and returned, with roughly equal percentages (54%-56%) for each specialty.

Multivariate analysis showed that surgeons who faced complications after emergency surgery that were not clearly the result of surgeon error were nearly twice as likely to agree to withdraw life-sustaining support, compared with surgeons evaluating elective procedures that had a complication resulting from surgeon error (odds ratio, 1.95). In addition, the odds of withdrawing life support were significantly greater among surgeons who were not optimistic about the patient’s future quality of life (OR, 1.75) and among those who were not concerned that the patients did not accurately value their future health state (OR, 1.59), compared with their counterparts, according to the authors.

"Iatrogenic complications that clearly derive from technical errors during elective procedures may pose considerable guilt and emotional burden upon surgeons," the authors speculated. "It is understandable that such factors should weigh on the surgeon. However, our findings call into question the degree to which these factors may unduly interfere with a patient’s ability to control his or her health care decisions."

In addition, "our data suggest that the commission of an error in surgical technique and prognostic optimism may present a challenge to patient autonomy. ... [This] suggests the importance of efforts to alleviate surgeons’ emotional strain while simultaneously respecting the fierce ethic of responsibility that surgeons possess for patients’ outcomes."

When a patient experiences a life-threatening complication and requests withdrawal of life-supporting therapy postoperatively, surgeons may be unlikely to do so without delay, according to the authors. "These decisions may be influenced by both the timing of surgery and whether the complication was the result of explicit technical error. In addition, these nonclinical factors may be associated with surgeons’ optimism about the patient’s postoperative quality of life," they concluded.

The authors reported that they had no financial disclosures.

Surgeons are more reluctant to withdraw life support if they made an error during surgery. This is especially true after an elective procedure, according to an extended analysis of a recent scenario-based survey of 2,100 surgeons who were involved in high-risk operations.

The survey included a series of questions regarding specialty-specific scenarios for 700 vascular surgeons (elective and emergent thoracoabdominal aortic aneurysm repair), 700 cardiothoracic surgeons (elective and emergent ascending aortic aneurysm repair), and 700 neurosurgeons (elective and emergent calcified right middle cerebral artery aneurysm clipping), according to Dr. Margaret L. Schwarze of the University of Wisconsin, Madison, and colleagues.

In the case of the vascular and the cardiac surgeons, the complication was the same: The "patient has weakness in left arm and leg when she awakes from anesthesia." The surgical error for the vascular surgeons was inadvertent placement of the proximal clamp so that it occluded the left carotid artery; for the cardiac surgeons, it was inadvertent dislodging of the arterial cannula. For both vascular and cardiac procedures, the non–error-caused complication resulted from unexplained intraoperative stroke.

The three specialties were chosen based on the presumption of routine high-risk operations, according to a report published online ahead of print in the Annals of Surgery (2012;256:10-15).

This analysis follows an earlier report in the Annals of Surgery by these same authors, who used these same survey data to determine that the majority of these surgeons performing high-risk operations did not discuss advanced directives with their patients, and 54% were unlikely to operate on these patients if they were aware of such directives prior to surgery (Ann. Surg. 2012;255:418-23).

Of the original 2,100 surveys that were sent out, 912 were completed and returned, with roughly equal percentages (54%-56%) for each specialty.

Multivariate analysis showed that surgeons who faced complications after emergency surgery that were not clearly the result of surgeon error were nearly twice as likely to agree to withdraw life-sustaining support, compared with surgeons evaluating elective procedures that had a complication resulting from surgeon error (odds ratio, 1.95). In addition, the odds of withdrawing life support were significantly greater among surgeons who were not optimistic about the patient’s future quality of life (OR, 1.75) and among those who were not concerned that the patients did not accurately value their future health state (OR, 1.59), compared with their counterparts, according to the authors.

"Iatrogenic complications that clearly derive from technical errors during elective procedures may pose considerable guilt and emotional burden upon surgeons," the authors speculated. "It is understandable that such factors should weigh on the surgeon. However, our findings call into question the degree to which these factors may unduly interfere with a patient’s ability to control his or her health care decisions."

In addition, "our data suggest that the commission of an error in surgical technique and prognostic optimism may present a challenge to patient autonomy. ... [This] suggests the importance of efforts to alleviate surgeons’ emotional strain while simultaneously respecting the fierce ethic of responsibility that surgeons possess for patients’ outcomes."

When a patient experiences a life-threatening complication and requests withdrawal of life-supporting therapy postoperatively, surgeons may be unlikely to do so without delay, according to the authors. "These decisions may be influenced by both the timing of surgery and whether the complication was the result of explicit technical error. In addition, these nonclinical factors may be associated with surgeons’ optimism about the patient’s postoperative quality of life," they concluded.

The authors reported that they had no financial disclosures.

Interns beginning their surgical training under the new resident duty-hour standards appear to be less pessimistic than program directors, but they still show significant concern that these new regulations will have a detrimental effect on the quality of their training, according to the results of separate surveys of surgical interns in general surgery residency programs and national surgical program directors.

The Accreditation Council for Graduate Medical Education (ACGME) implemented the new standards in July 2011 to include increased supervision and a 16-hour shift maximum for postgraduate year 1 residents, according to a report published in the June issue of Archives of Surgery.

In the summer of 2011, the researchers surveyed all 215 surgical interns in 11 general surgical residency programs distributed across the country to assess their perceptions of how the new duty-hour requirements would affect continuity of care, resident fatigue, and development in the six core ACGME competencies, according to Dr. Ryan M. Antiel of the Mayo Clinic, Rochester, Minn., and his colleagues. Perceptions were measured using a 3-point scale (increase, decrease, no change) for each item. A total of 179 (83.3%) completed the survey. Most respondents (68.7%) were men and were younger than 29 years of age (73%), with 102 categorical interns (57%) and 76 preliminary interns (42.5%), and 1 nonrespondent to this question (Arch. Surg. 2012;147:536-41).

Results of the resident survey were compared with those of an earlier survey of 134 program directors conducted by Dr. Antiel and his colleagues (Mayo Clin. Proc. 2011;86:185-91).

The great majority of the interns (80.3%) indicated that the new restrictions would decrease their ability to achieve continuity with hospitalized patients, and more than half (57.6%) stated that there would be a decrease in the coordination of patient care. Slightly fewer than half (48%) believed it would interfere with their acquisition of new medical knowledge.

"Most of the surgical interns (67.4%) believed that the duty-hour restrictions will decrease their time spent in the operating room," the researchers added. They also indicated that the new standards would decrease their development of surgical skills (52.8%); their time spent with patients on the floor (51.1%); and their overall educational experience (51.1%). Categorical interns were significantly more likely to believe that the changes would decrease both quality and safety of patient care (odds ratio, 2.6).

However, some optimism was also expressed: In all, 61.5% of interns believed that the new standards would decrease resident fatigue; 66.5% indicated that the new hours would increase or not change quality and safety of patient care; 72.1% indicated the same for the ability to effectively communicate with patients, families, and other health professionals; 74.7% indicated the same for the resident’s investigation and self-evaluation of their own patient care; and 70.2% felt that the impact would be neutral or favorable in the area of responsiveness to patient needs that supersede self-interest.

Compared with the program directors surveyed, a significantly higher proportion of interns believed that the new changes would improve or not change residents’ performance. And a significantly larger percentage of program directors agreed that the new changes would decrease coordination of patient care and residents’ acquisition of medical knowledge (76.9% vs. 48.0%). Perhaps most notably in terms of cross-perceptions, most interns (61.5%) believed that the new changes would decrease fatigue, whereas 85.1% of program directors believed that the new hours would increase fatigue, presumably by increasing the intensity of effort and accomplishments required in that shorter amount of time, according to the authors.

Dr. Antiel and his colleagues pointed out several limitations to their study beyond those intrinsic to the nature of surveys. Attitudes of residents may change over time, although the survey was most concerned with the perception of incoming interns. Also, program directors were not chosen randomly, and some regions may have been underrepresented. In addition, attitudes cannot be taken as evidence of the actual results of duty-hour restrictions on training, only the perceptions of that effect. But in the absence of defined metrics for assessing the effect of duty-hour restrictions on training, the attitudes of those most intimately involved in training may be the best metric available, the researchers noted.

"As residency programs attempt to adapt to the new regulations, surgical interns have significant concerns about the implications of these regulations on their training. The opinions of these interns, although markedly more optimistic than those of surgical program directors, reflect a persistent concern within the surgical community regarding the effects of work-hour restrictions on surgical training," the researchers concluded.

Eliminating two important limitations of this study might have put the interns more "in sync" with the program directors, noted Dr. Mark L. Friedell, who wrote an invited critique of the report (Arch. Surg. 2012;147:541). "First, large university programs constituted 10 of the 11 surveyed, and I suspect that those residents would be less concerned about duty-hour restrictions" (because more of them subsequently choose fellowships and are less likely to go straight into general surgery practice) than would those from nonuniversity or community programs, he wrote. Second, for 42.5% of the interns surveyed, there was no distinction made between those hoping to go into general surgery vs. those on track for surgical subspecialties, who are less likely to be concerned for the same reason of expecting additional training.

"Even when we ignore the limitations of this study, I believe it shows that the "line in the sand" for the entire surgical community – residents and attendings – is no further resident duty-hour restrictions," concluded Dr. Friedell of the department of surgery at the University of Missouri–Kansas City.

The authors reported that they had no financial disclosures. Dr. Friedell reported having no disclosures.

Interns beginning their surgical training under the new resident duty-hour standards appear to be less pessimistic than program directors, but they still show significant concern that these new regulations will have a detrimental effect on the quality of their training, according to the results of separate surveys of surgical interns in general surgery residency programs and national surgical program directors.

The Accreditation Council for Graduate Medical Education (ACGME) implemented the new standards in July 2011 to include increased supervision and a 16-hour shift maximum for postgraduate year 1 residents, according to a report published in the June issue of Archives of Surgery.

In the summer of 2011, the researchers surveyed all 215 surgical interns in 11 general surgical residency programs distributed across the country to assess their perceptions of how the new duty-hour requirements would affect continuity of care, resident fatigue, and development in the six core ACGME competencies, according to Dr. Ryan M. Antiel of the Mayo Clinic, Rochester, Minn., and his colleagues. Perceptions were measured using a 3-point scale (increase, decrease, no change) for each item. A total of 179 (83.3%) completed the survey. Most respondents (68.7%) were men and were younger than 29 years of age (73%), with 102 categorical interns (57%) and 76 preliminary interns (42.5%), and 1 nonrespondent to this question (Arch. Surg. 2012;147:536-41).

Results of the resident survey were compared with those of an earlier survey of 134 program directors conducted by Dr. Antiel and his colleagues (Mayo Clin. Proc. 2011;86:185-91).

The great majority of the interns (80.3%) indicated that the new restrictions would decrease their ability to achieve continuity with hospitalized patients, and more than half (57.6%) stated that there would be a decrease in the coordination of patient care. Slightly fewer than half (48%) believed it would interfere with their acquisition of new medical knowledge.

"Most of the surgical interns (67.4%) believed that the duty-hour restrictions will decrease their time spent in the operating room," the researchers added. They also indicated that the new standards would decrease their development of surgical skills (52.8%); their time spent with patients on the floor (51.1%); and their overall educational experience (51.1%). Categorical interns were significantly more likely to believe that the changes would decrease both quality and safety of patient care (odds ratio, 2.6).

However, some optimism was also expressed: In all, 61.5% of interns believed that the new standards would decrease resident fatigue; 66.5% indicated that the new hours would increase or not change quality and safety of patient care; 72.1% indicated the same for the ability to effectively communicate with patients, families, and other health professionals; 74.7% indicated the same for the resident’s investigation and self-evaluation of their own patient care; and 70.2% felt that the impact would be neutral or favorable in the area of responsiveness to patient needs that supersede self-interest.

Compared with the program directors surveyed, a significantly higher proportion of interns believed that the new changes would improve or not change residents’ performance. And a significantly larger percentage of program directors agreed that the new changes would decrease coordination of patient care and residents’ acquisition of medical knowledge (76.9% vs. 48.0%). Perhaps most notably in terms of cross-perceptions, most interns (61.5%) believed that the new changes would decrease fatigue, whereas 85.1% of program directors believed that the new hours would increase fatigue, presumably by increasing the intensity of effort and accomplishments required in that shorter amount of time, according to the authors.

Dr. Antiel and his colleagues pointed out several limitations to their study beyond those intrinsic to the nature of surveys. Attitudes of residents may change over time, although the survey was most concerned with the perception of incoming interns. Also, program directors were not chosen randomly, and some regions may have been underrepresented. In addition, attitudes cannot be taken as evidence of the actual results of duty-hour restrictions on training, only the perceptions of that effect. But in the absence of defined metrics for assessing the effect of duty-hour restrictions on training, the attitudes of those most intimately involved in training may be the best metric available, the researchers noted.

"As residency programs attempt to adapt to the new regulations, surgical interns have significant concerns about the implications of these regulations on their training. The opinions of these interns, although markedly more optimistic than those of surgical program directors, reflect a persistent concern within the surgical community regarding the effects of work-hour restrictions on surgical training," the researchers concluded.

Eliminating two important limitations of this study might have put the interns more "in sync" with the program directors, noted Dr. Mark L. Friedell, who wrote an invited critique of the report (Arch. Surg. 2012;147:541). "First, large university programs constituted 10 of the 11 surveyed, and I suspect that those residents would be less concerned about duty-hour restrictions" (because more of them subsequently choose fellowships and are less likely to go straight into general surgery practice) than would those from nonuniversity or community programs, he wrote. Second, for 42.5% of the interns surveyed, there was no distinction made between those hoping to go into general surgery vs. those on track for surgical subspecialties, who are less likely to be concerned for the same reason of expecting additional training.

"Even when we ignore the limitations of this study, I believe it shows that the "line in the sand" for the entire surgical community – residents and attendings – is no further resident duty-hour restrictions," concluded Dr. Friedell of the department of surgery at the University of Missouri–Kansas City.

The authors reported that they had no financial disclosures. Dr. Friedell reported having no disclosures.

Interns beginning their surgical training under the new resident duty-hour standards appear to be less pessimistic than program directors, but they still show significant concern that these new regulations will have a detrimental effect on the quality of their training, according to the results of separate surveys of surgical interns in general surgery residency programs and national surgical program directors.

The Accreditation Council for Graduate Medical Education (ACGME) implemented the new standards in July 2011 to include increased supervision and a 16-hour shift maximum for postgraduate year 1 residents, according to a report published in the June issue of Archives of Surgery.

In the summer of 2011, the researchers surveyed all 215 surgical interns in 11 general surgical residency programs distributed across the country to assess their perceptions of how the new duty-hour requirements would affect continuity of care, resident fatigue, and development in the six core ACGME competencies, according to Dr. Ryan M. Antiel of the Mayo Clinic, Rochester, Minn., and his colleagues. Perceptions were measured using a 3-point scale (increase, decrease, no change) for each item. A total of 179 (83.3%) completed the survey. Most respondents (68.7%) were men and were younger than 29 years of age (73%), with 102 categorical interns (57%) and 76 preliminary interns (42.5%), and 1 nonrespondent to this question (Arch. Surg. 2012;147:536-41).

Results of the resident survey were compared with those of an earlier survey of 134 program directors conducted by Dr. Antiel and his colleagues (Mayo Clin. Proc. 2011;86:185-91).

The great majority of the interns (80.3%) indicated that the new restrictions would decrease their ability to achieve continuity with hospitalized patients, and more than half (57.6%) stated that there would be a decrease in the coordination of patient care. Slightly fewer than half (48%) believed it would interfere with their acquisition of new medical knowledge.

"Most of the surgical interns (67.4%) believed that the duty-hour restrictions will decrease their time spent in the operating room," the researchers added. They also indicated that the new standards would decrease their development of surgical skills (52.8%); their time spent with patients on the floor (51.1%); and their overall educational experience (51.1%). Categorical interns were significantly more likely to believe that the changes would decrease both quality and safety of patient care (odds ratio, 2.6).

However, some optimism was also expressed: In all, 61.5% of interns believed that the new standards would decrease resident fatigue; 66.5% indicated that the new hours would increase or not change quality and safety of patient care; 72.1% indicated the same for the ability to effectively communicate with patients, families, and other health professionals; 74.7% indicated the same for the resident’s investigation and self-evaluation of their own patient care; and 70.2% felt that the impact would be neutral or favorable in the area of responsiveness to patient needs that supersede self-interest.

Compared with the program directors surveyed, a significantly higher proportion of interns believed that the new changes would improve or not change residents’ performance. And a significantly larger percentage of program directors agreed that the new changes would decrease coordination of patient care and residents’ acquisition of medical knowledge (76.9% vs. 48.0%). Perhaps most notably in terms of cross-perceptions, most interns (61.5%) believed that the new changes would decrease fatigue, whereas 85.1% of program directors believed that the new hours would increase fatigue, presumably by increasing the intensity of effort and accomplishments required in that shorter amount of time, according to the authors.

Dr. Antiel and his colleagues pointed out several limitations to their study beyond those intrinsic to the nature of surveys. Attitudes of residents may change over time, although the survey was most concerned with the perception of incoming interns. Also, program directors were not chosen randomly, and some regions may have been underrepresented. In addition, attitudes cannot be taken as evidence of the actual results of duty-hour restrictions on training, only the perceptions of that effect. But in the absence of defined metrics for assessing the effect of duty-hour restrictions on training, the attitudes of those most intimately involved in training may be the best metric available, the researchers noted.

"As residency programs attempt to adapt to the new regulations, surgical interns have significant concerns about the implications of these regulations on their training. The opinions of these interns, although markedly more optimistic than those of surgical program directors, reflect a persistent concern within the surgical community regarding the effects of work-hour restrictions on surgical training," the researchers concluded.

Eliminating two important limitations of this study might have put the interns more "in sync" with the program directors, noted Dr. Mark L. Friedell, who wrote an invited critique of the report (Arch. Surg. 2012;147:541). "First, large university programs constituted 10 of the 11 surveyed, and I suspect that those residents would be less concerned about duty-hour restrictions" (because more of them subsequently choose fellowships and are less likely to go straight into general surgery practice) than would those from nonuniversity or community programs, he wrote. Second, for 42.5% of the interns surveyed, there was no distinction made between those hoping to go into general surgery vs. those on track for surgical subspecialties, who are less likely to be concerned for the same reason of expecting additional training.

"Even when we ignore the limitations of this study, I believe it shows that the "line in the sand" for the entire surgical community – residents and attendings – is no further resident duty-hour restrictions," concluded Dr. Friedell of the department of surgery at the University of Missouri–Kansas City.

The authors reported that they had no financial disclosures. Dr. Friedell reported having no disclosures.

San Francisco – The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTDB) is the largest clinical thoracic surgical database in the United States. However, it is not known whether the outstanding outcomes for esophageal cancer resection from the GTDB are representative of nationwide results, said Dr. Benjamin D. Kozower at the annual meeting of the American Association for Thoracic Surgery. He and his colleagues at the University of Virginia performed a study to see if GTDB esophagectomy outcomes are representative of nationwide outcomes by comparing them to other national clinical and administrative databases.

From 2002 to 2008, esophageal cancer resection outcomes from the GTDB were compared with the National Surgery Quality Improvement Program (NSQIP) and the Nationwide Inpatient Sample (NIS), the largest all-payer, inpatient care database in the United States. Primary outcomes were the number of procedures reported from each database and differences in mortality and resource utilization. Observed differences in patient characteristics and postoperative events were also analyzed.

Annual esophageal resection volume has increased over time. However, the GTDB (n = 6,740) and NSQIP (n = 1,030) capture only a small proportion of resections performed nationally: 30% and 5%, respectively. Median patient age was between 64 and 65 years; between 18% and 21% were women, similar in all three databases. Mortality was significantly lower within the GTDB (3.2%) and NSQIP (2.6%) compared with the NIS (6.1%). In addition, the median length of stay was lower in the GTDB (10 days) compared with both the NSQIP (12 days) and NIS (12 days).

"The STS GTDB reports outstanding mortality results and hospital resource utilization for esophageal cancer resection. However, surgical outcomes from the STS GTDB are not representative of national results from programs not participating in the database," said Dr. Kozower.

"These results establish a reference for future esophagectomy comparisons and highlight the importance of increased participation and utilization of the STS GTDB," he concluded.

San Francisco – The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTDB) is the largest clinical thoracic surgical database in the United States. However, it is not known whether the outstanding outcomes for esophageal cancer resection from the GTDB are representative of nationwide results, said Dr. Benjamin D. Kozower at the annual meeting of the American Association for Thoracic Surgery. He and his colleagues at the University of Virginia performed a study to see if GTDB esophagectomy outcomes are representative of nationwide outcomes by comparing them to other national clinical and administrative databases.

From 2002 to 2008, esophageal cancer resection outcomes from the GTDB were compared with the National Surgery Quality Improvement Program (NSQIP) and the Nationwide Inpatient Sample (NIS), the largest all-payer, inpatient care database in the United States. Primary outcomes were the number of procedures reported from each database and differences in mortality and resource utilization. Observed differences in patient characteristics and postoperative events were also analyzed.

Annual esophageal resection volume has increased over time. However, the GTDB (n = 6,740) and NSQIP (n = 1,030) capture only a small proportion of resections performed nationally: 30% and 5%, respectively. Median patient age was between 64 and 65 years; between 18% and 21% were women, similar in all three databases. Mortality was significantly lower within the GTDB (3.2%) and NSQIP (2.6%) compared with the NIS (6.1%). In addition, the median length of stay was lower in the GTDB (10 days) compared with both the NSQIP (12 days) and NIS (12 days).

"The STS GTDB reports outstanding mortality results and hospital resource utilization for esophageal cancer resection. However, surgical outcomes from the STS GTDB are not representative of national results from programs not participating in the database," said Dr. Kozower.

"These results establish a reference for future esophagectomy comparisons and highlight the importance of increased participation and utilization of the STS GTDB," he concluded.

San Francisco – The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTDB) is the largest clinical thoracic surgical database in the United States. However, it is not known whether the outstanding outcomes for esophageal cancer resection from the GTDB are representative of nationwide results, said Dr. Benjamin D. Kozower at the annual meeting of the American Association for Thoracic Surgery. He and his colleagues at the University of Virginia performed a study to see if GTDB esophagectomy outcomes are representative of nationwide outcomes by comparing them to other national clinical and administrative databases.

From 2002 to 2008, esophageal cancer resection outcomes from the GTDB were compared with the National Surgery Quality Improvement Program (NSQIP) and the Nationwide Inpatient Sample (NIS), the largest all-payer, inpatient care database in the United States. Primary outcomes were the number of procedures reported from each database and differences in mortality and resource utilization. Observed differences in patient characteristics and postoperative events were also analyzed.

Annual esophageal resection volume has increased over time. However, the GTDB (n = 6,740) and NSQIP (n = 1,030) capture only a small proportion of resections performed nationally: 30% and 5%, respectively. Median patient age was between 64 and 65 years; between 18% and 21% were women, similar in all three databases. Mortality was significantly lower within the GTDB (3.2%) and NSQIP (2.6%) compared with the NIS (6.1%). In addition, the median length of stay was lower in the GTDB (10 days) compared with both the NSQIP (12 days) and NIS (12 days).

"The STS GTDB reports outstanding mortality results and hospital resource utilization for esophageal cancer resection. However, surgical outcomes from the STS GTDB are not representative of national results from programs not participating in the database," said Dr. Kozower.

"These results establish a reference for future esophagectomy comparisons and highlight the importance of increased participation and utilization of the STS GTDB," he concluded.

San Francisco – The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTDB) is the largest clinical thoracic surgical database in the United States. However, it is not known whether the outstanding outcomes for esophageal cancer resection from the GTDB are representative of nationwide results, said Dr. Benjamin D. Kozower at the annual meeting of the American Association for Thoracic Surgery. He and his colleagues at the University of Virginia performed a study to see if GTDB esophagectomy outcomes are representative of nationwide outcomes by comparing them to other national clinical and administrative databases.

From 2002 to 2008, esophageal cancer resection outcomes from the GTDB were compared with the National Surgery Quality Improvement Program (NSQIP) and the Nationwide Inpatient Sample (NIS), the largest all-payer, inpatient care database in the United States. Primary outcomes were the number of procedures reported from each database and differences in mortality and resource utilization. Observed differences in patient characteristics and postoperative events were also analyzed.

Annual esophageal resection volume has increased over time. However, the GTDB (n = 6,740) and NSQIP (n = 1,030) capture only a small proportion of resections performed nationally: 30% and 5%, respectively. Median patient age was between 64 and 65 years; between 18% and 21% were women, similar in all three databases. Mortality was significantly lower within the GTDB (3.2%) and NSQIP (2.6%) compared with the NIS (6.1%). In addition, the median length of stay was lower in the GTDB (10 days) compared with both the NSQIP (12 days) and NIS (12 days).

"The STS GTDB reports outstanding mortality results and hospital resource utilization for esophageal cancer resection. However, surgical outcomes from the STS GTDB are not representative of national results from programs not participating in the database," said Dr. Kozower.

"These results establish a reference for future esophagectomy comparisons and highlight the importance of increased participation and utilization of the STS GTDB," he concluded.

San Francisco – The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTDB) is the largest clinical thoracic surgical database in the United States. However, it is not known whether the outstanding outcomes for esophageal cancer resection from the GTDB are representative of nationwide results, said Dr. Benjamin D. Kozower at the annual meeting of the American Association for Thoracic Surgery. He and his colleagues at the University of Virginia performed a study to see if GTDB esophagectomy outcomes are representative of nationwide outcomes by comparing them to other national clinical and administrative databases.

From 2002 to 2008, esophageal cancer resection outcomes from the GTDB were compared with the National Surgery Quality Improvement Program (NSQIP) and the Nationwide Inpatient Sample (NIS), the largest all-payer, inpatient care database in the United States. Primary outcomes were the number of procedures reported from each database and differences in mortality and resource utilization. Observed differences in patient characteristics and postoperative events were also analyzed.

Annual esophageal resection volume has increased over time. However, the GTDB (n = 6,740) and NSQIP (n = 1,030) capture only a small proportion of resections performed nationally: 30% and 5%, respectively. Median patient age was between 64 and 65 years; between 18% and 21% were women, similar in all three databases. Mortality was significantly lower within the GTDB (3.2%) and NSQIP (2.6%) compared with the NIS (6.1%). In addition, the median length of stay was lower in the GTDB (10 days) compared with both the NSQIP (12 days) and NIS (12 days).

"The STS GTDB reports outstanding mortality results and hospital resource utilization for esophageal cancer resection. However, surgical outcomes from the STS GTDB are not representative of national results from programs not participating in the database," said Dr. Kozower.

"These results establish a reference for future esophagectomy comparisons and highlight the importance of increased participation and utilization of the STS GTDB," he concluded.

San Francisco – The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTDB) is the largest clinical thoracic surgical database in the United States. However, it is not known whether the outstanding outcomes for esophageal cancer resection from the GTDB are representative of nationwide results, said Dr. Benjamin D. Kozower at the annual meeting of the American Association for Thoracic Surgery. He and his colleagues at the University of Virginia performed a study to see if GTDB esophagectomy outcomes are representative of nationwide outcomes by comparing them to other national clinical and administrative databases.

From 2002 to 2008, esophageal cancer resection outcomes from the GTDB were compared with the National Surgery Quality Improvement Program (NSQIP) and the Nationwide Inpatient Sample (NIS), the largest all-payer, inpatient care database in the United States. Primary outcomes were the number of procedures reported from each database and differences in mortality and resource utilization. Observed differences in patient characteristics and postoperative events were also analyzed.

Annual esophageal resection volume has increased over time. However, the GTDB (n = 6,740) and NSQIP (n = 1,030) capture only a small proportion of resections performed nationally: 30% and 5%, respectively. Median patient age was between 64 and 65 years; between 18% and 21% were women, similar in all three databases. Mortality was significantly lower within the GTDB (3.2%) and NSQIP (2.6%) compared with the NIS (6.1%). In addition, the median length of stay was lower in the GTDB (10 days) compared with both the NSQIP (12 days) and NIS (12 days).

"The STS GTDB reports outstanding mortality results and hospital resource utilization for esophageal cancer resection. However, surgical outcomes from the STS GTDB are not representative of national results from programs not participating in the database," said Dr. Kozower.

"These results establish a reference for future esophagectomy comparisons and highlight the importance of increased participation and utilization of the STS GTDB," he concluded.

SAN FRANCISCO – The American Association for Thoracic Surgery (AATS) Council approved new lung cancer screening guidelines at this year’s AATS Annual Meeting. A summary of the new "Guidelines for Lung Cancer Screening using Low Dose Computed Tomography (LDCT) Scans for Lung Cancer Survivors and Other High Risk Groups: Report of the AATS Lung Cancer Screening and Surveillance Task Force," was presented by Dr. Michael T. Jaklitsch.

Dr. Jaklitisch, a thoracic surgeon at Brigham and Women’s Hospital and an associate professor of surgery at Harvard Medical School, Boston, is the co-chair of the AATS Lung Cancer Screening and Surveillance Task Force along with Dr. Francine Jacobson, assistant professor of radiology at the hospital.

The AATS established the Lung Cancer Screening and Surveillance Task Force (LCSSTF) to create these guidelines for both smokers at high risk for lung cancer and lung cancer survivors in response to the publication of the National Lung Screening Trial (NLST), a randomized phase III trial, published in August 2011. The trial provided level 1 evidence that low-dose chest CT screening reduced lung cancer specific mortality by 20%.

Other societies such as the American Lung Association have also responded to the NLST trial with similar recommendations.

"Roughly 7 million out of 94 million current and former smokers in the United States meet the NLST criteria for highest risk screening. More than 75% of the positive screening tests resulted in additional testing, most frequently by repeat imaging. Less than 10% of the tests required an invasive procedure for further work-up," according to the Task Force.

The Task Force reported that the radiation exposure from LDCT appears to be negligible. They cited the fact that the average effective dose per scan in the NLST trial was 1.5 mSv and that the American Association of Physicists in Medicine, in a position statement on radiation risks from medical imaging procedures in December 2011, stated: "Risks of medical imaging at effective doses below 50 mSv for single procedures or 100 mSv for multiple procedures over short time periods are too low to be detectable, and may be nonexistent."

The Task Force also recommends the provision of care by an interdisciplinary team of thoracic surgeons working with radiologists, pulmonologists and oncologists. Such a team is "required to ensure decreased mortality from lung cancer outside of strict clinical trials in academic centers, including 0.5% operative mortality, and appropriate minimally invasive capabilities such as VATS."

The Task Force also indicated that it is "most desirable to create a program for lung cancer screening that also supports smoking cessation." Throughout the process there should be data gathered to "allow study of outcomes that are important for the practice of evidence-based medicine in the era of personalized health care."

In a summary statement of their new guidelines, the AATS recommended lung cancer screening for 3 distinct groups:

1) Level 1 evidence in favor of screening currently exists for North Americans between the ages of 55 and 79 with a 30 pack-year smoking history.

2) Lung cancer survivors are an extremely high risk group for developing a second lung cancer, and should be screened with LDCT starting 5 years after treatment.

3) Younger patients (age 50) with a 20 pack-year smoking history should be screened if they have an additional risk factor that produces a 5% risk of developing a lung cancer over the next 5 years. "At our current state of knowledge, that includes patients with documented radon exposure, occupational exposure, a lung cancer history in a first-degree relative if that cancer was recognized at a young age, COPD with an FEV1 of greater than 70%, and a tissue diagnosis of pulmonary fibrosis," according to the Task Force.

As costs are always of concern in proposing any new screening program, the Task Force discussed a recent estimate of the cost and benefit of annual lung cancer screening offered as a commercial insurance benefit for high risk Americans aged 50-64 years. That estimate found a screening cost of $1 per insured member per month in 2012 dollars.

The cost per life-year saved would be below $19,000. This compares favorably to cost per life-year saved in breast ($31,000 to $52,000), colon ($19,000 to $29,000), and cervical cancers ($50,000 to $75,000), the Task Force added.

The Task Force worked through an interdisciplinary consensus process, and its members were selected for their leadership in lung cancer screening, diagnosis, treatment, and follow-up of patient who have nodules and lung cancer. The fourteen individual members of the LCSSTF comprised: an epidemiologist, a pulmonologist, a pathologist, three medical oncologists, four thoracic radiologists, and four thoracic surgeons.

The idea of establishing a Task Force to create these consensus guidelines for the AATS was conceived by Dr. David J. Sugarbaker, chief of the Division of Thoracic Surgery at Brigham and Women’s Hospital. Other AATS members included on the Task Force are Dr. Shaf Keshavjee, director of the Toronto Lung Transplant Program at the University of Toronto, and Dr. Scott Swanson, professor of surgery at Brigham and Women’s Hospital.

The members of the Task Force reported no relevant disclosures.

SAN FRANCISCO – The American Association for Thoracic Surgery (AATS) Council approved new lung cancer screening guidelines at this year’s AATS Annual Meeting. A summary of the new "Guidelines for Lung Cancer Screening using Low Dose Computed Tomography (LDCT) Scans for Lung Cancer Survivors and Other High Risk Groups: Report of the AATS Lung Cancer Screening and Surveillance Task Force," was presented by Dr. Michael T. Jaklitsch.

Dr. Jaklitisch, a thoracic surgeon at Brigham and Women’s Hospital and an associate professor of surgery at Harvard Medical School, Boston, is the co-chair of the AATS Lung Cancer Screening and Surveillance Task Force along with Dr. Francine Jacobson, assistant professor of radiology at the hospital.

The AATS established the Lung Cancer Screening and Surveillance Task Force (LCSSTF) to create these guidelines for both smokers at high risk for lung cancer and lung cancer survivors in response to the publication of the National Lung Screening Trial (NLST), a randomized phase III trial, published in August 2011. The trial provided level 1 evidence that low-dose chest CT screening reduced lung cancer specific mortality by 20%.

Other societies such as the American Lung Association have also responded to the NLST trial with similar recommendations.

"Roughly 7 million out of 94 million current and former smokers in the United States meet the NLST criteria for highest risk screening. More than 75% of the positive screening tests resulted in additional testing, most frequently by repeat imaging. Less than 10% of the tests required an invasive procedure for further work-up," according to the Task Force.

The Task Force reported that the radiation exposure from LDCT appears to be negligible. They cited the fact that the average effective dose per scan in the NLST trial was 1.5 mSv and that the American Association of Physicists in Medicine, in a position statement on radiation risks from medical imaging procedures in December 2011, stated: "Risks of medical imaging at effective doses below 50 mSv for single procedures or 100 mSv for multiple procedures over short time periods are too low to be detectable, and may be nonexistent."

The Task Force also recommends the provision of care by an interdisciplinary team of thoracic surgeons working with radiologists, pulmonologists and oncologists. Such a team is "required to ensure decreased mortality from lung cancer outside of strict clinical trials in academic centers, including 0.5% operative mortality, and appropriate minimally invasive capabilities such as VATS."

The Task Force also indicated that it is "most desirable to create a program for lung cancer screening that also supports smoking cessation." Throughout the process there should be data gathered to "allow study of outcomes that are important for the practice of evidence-based medicine in the era of personalized health care."

In a summary statement of their new guidelines, the AATS recommended lung cancer screening for 3 distinct groups:

1) Level 1 evidence in favor of screening currently exists for North Americans between the ages of 55 and 79 with a 30 pack-year smoking history.

2) Lung cancer survivors are an extremely high risk group for developing a second lung cancer, and should be screened with LDCT starting 5 years after treatment.

3) Younger patients (age 50) with a 20 pack-year smoking history should be screened if they have an additional risk factor that produces a 5% risk of developing a lung cancer over the next 5 years. "At our current state of knowledge, that includes patients with documented radon exposure, occupational exposure, a lung cancer history in a first-degree relative if that cancer was recognized at a young age, COPD with an FEV1 of greater than 70%, and a tissue diagnosis of pulmonary fibrosis," according to the Task Force.

As costs are always of concern in proposing any new screening program, the Task Force discussed a recent estimate of the cost and benefit of annual lung cancer screening offered as a commercial insurance benefit for high risk Americans aged 50-64 years. That estimate found a screening cost of $1 per insured member per month in 2012 dollars.

The cost per life-year saved would be below $19,000. This compares favorably to cost per life-year saved in breast ($31,000 to $52,000), colon ($19,000 to $29,000), and cervical cancers ($50,000 to $75,000), the Task Force added.

The Task Force worked through an interdisciplinary consensus process, and its members were selected for their leadership in lung cancer screening, diagnosis, treatment, and follow-up of patient who have nodules and lung cancer. The fourteen individual members of the LCSSTF comprised: an epidemiologist, a pulmonologist, a pathologist, three medical oncologists, four thoracic radiologists, and four thoracic surgeons.

The idea of establishing a Task Force to create these consensus guidelines for the AATS was conceived by Dr. David J. Sugarbaker, chief of the Division of Thoracic Surgery at Brigham and Women’s Hospital. Other AATS members included on the Task Force are Dr. Shaf Keshavjee, director of the Toronto Lung Transplant Program at the University of Toronto, and Dr. Scott Swanson, professor of surgery at Brigham and Women’s Hospital.

The members of the Task Force reported no relevant disclosures.

SAN FRANCISCO – The American Association for Thoracic Surgery (AATS) Council approved new lung cancer screening guidelines at this year’s AATS Annual Meeting. A summary of the new "Guidelines for Lung Cancer Screening using Low Dose Computed Tomography (LDCT) Scans for Lung Cancer Survivors and Other High Risk Groups: Report of the AATS Lung Cancer Screening and Surveillance Task Force," was presented by Dr. Michael T. Jaklitsch.

Dr. Jaklitisch, a thoracic surgeon at Brigham and Women’s Hospital and an associate professor of surgery at Harvard Medical School, Boston, is the co-chair of the AATS Lung Cancer Screening and Surveillance Task Force along with Dr. Francine Jacobson, assistant professor of radiology at the hospital.

The AATS established the Lung Cancer Screening and Surveillance Task Force (LCSSTF) to create these guidelines for both smokers at high risk for lung cancer and lung cancer survivors in response to the publication of the National Lung Screening Trial (NLST), a randomized phase III trial, published in August 2011. The trial provided level 1 evidence that low-dose chest CT screening reduced lung cancer specific mortality by 20%.

Other societies such as the American Lung Association have also responded to the NLST trial with similar recommendations.

"Roughly 7 million out of 94 million current and former smokers in the United States meet the NLST criteria for highest risk screening. More than 75% of the positive screening tests resulted in additional testing, most frequently by repeat imaging. Less than 10% of the tests required an invasive procedure for further work-up," according to the Task Force.

The Task Force reported that the radiation exposure from LDCT appears to be negligible. They cited the fact that the average effective dose per scan in the NLST trial was 1.5 mSv and that the American Association of Physicists in Medicine, in a position statement on radiation risks from medical imaging procedures in December 2011, stated: "Risks of medical imaging at effective doses below 50 mSv for single procedures or 100 mSv for multiple procedures over short time periods are too low to be detectable, and may be nonexistent."

The Task Force also recommends the provision of care by an interdisciplinary team of thoracic surgeons working with radiologists, pulmonologists and oncologists. Such a team is "required to ensure decreased mortality from lung cancer outside of strict clinical trials in academic centers, including 0.5% operative mortality, and appropriate minimally invasive capabilities such as VATS."

The Task Force also indicated that it is "most desirable to create a program for lung cancer screening that also supports smoking cessation." Throughout the process there should be data gathered to "allow study of outcomes that are important for the practice of evidence-based medicine in the era of personalized health care."

In a summary statement of their new guidelines, the AATS recommended lung cancer screening for 3 distinct groups:

1) Level 1 evidence in favor of screening currently exists for North Americans between the ages of 55 and 79 with a 30 pack-year smoking history.

2) Lung cancer survivors are an extremely high risk group for developing a second lung cancer, and should be screened with LDCT starting 5 years after treatment.

3) Younger patients (age 50) with a 20 pack-year smoking history should be screened if they have an additional risk factor that produces a 5% risk of developing a lung cancer over the next 5 years. "At our current state of knowledge, that includes patients with documented radon exposure, occupational exposure, a lung cancer history in a first-degree relative if that cancer was recognized at a young age, COPD with an FEV1 of greater than 70%, and a tissue diagnosis of pulmonary fibrosis," according to the Task Force.

As costs are always of concern in proposing any new screening program, the Task Force discussed a recent estimate of the cost and benefit of annual lung cancer screening offered as a commercial insurance benefit for high risk Americans aged 50-64 years. That estimate found a screening cost of $1 per insured member per month in 2012 dollars.

The cost per life-year saved would be below $19,000. This compares favorably to cost per life-year saved in breast ($31,000 to $52,000), colon ($19,000 to $29,000), and cervical cancers ($50,000 to $75,000), the Task Force added.

The Task Force worked through an interdisciplinary consensus process, and its members were selected for their leadership in lung cancer screening, diagnosis, treatment, and follow-up of patient who have nodules and lung cancer. The fourteen individual members of the LCSSTF comprised: an epidemiologist, a pulmonologist, a pathologist, three medical oncologists, four thoracic radiologists, and four thoracic surgeons.

The idea of establishing a Task Force to create these consensus guidelines for the AATS was conceived by Dr. David J. Sugarbaker, chief of the Division of Thoracic Surgery at Brigham and Women’s Hospital. Other AATS members included on the Task Force are Dr. Shaf Keshavjee, director of the Toronto Lung Transplant Program at the University of Toronto, and Dr. Scott Swanson, professor of surgery at Brigham and Women’s Hospital.

The members of the Task Force reported no relevant disclosures.

SAN FRANCISCO – The American Association for Thoracic Surgery (AATS) Council approved new lung cancer screening guidelines at this year’s AATS Annual Meeting. A summary of the new "Guidelines for Lung Cancer Screening using Low Dose Computed Tomography (LDCT) Scans for Lung Cancer Survivors and Other High Risk Groups: Report of the AATS Lung Cancer Screening and Surveillance Task Force," was presented by Dr. Michael T. Jaklitsch.

Dr. Jaklitisch, a thoracic surgeon at Brigham and Women’s Hospital and an associate professor of surgery at Harvard Medical School, Boston, is the co-chair of the AATS Lung Cancer Screening and Surveillance Task Force along with Dr. Francine Jacobson, assistant professor of radiology at the hospital.

The AATS established the Lung Cancer Screening and Surveillance Task Force (LCSSTF) to create these guidelines for both smokers at high risk for lung cancer and lung cancer survivors in response to the publication of the National Lung Screening Trial (NLST), a randomized phase III trial, published in August 2011. The trial provided level 1 evidence that low-dose chest CT screening reduced lung cancer specific mortality by 20%.

Other societies such as the American Lung Association have also responded to the NLST trial with similar recommendations.

"Roughly 7 million out of 94 million current and former smokers in the United States meet the NLST criteria for highest risk screening. More than 75% of the positive screening tests resulted in additional testing, most frequently by repeat imaging. Less than 10% of the tests required an invasive procedure for further work-up," according to the Task Force.

The Task Force reported that the radiation exposure from LDCT appears to be negligible. They cited the fact that the average effective dose per scan in the NLST trial was 1.5 mSv and that the American Association of Physicists in Medicine, in a position statement on radiation risks from medical imaging procedures in December 2011, stated: "Risks of medical imaging at effective doses below 50 mSv for single procedures or 100 mSv for multiple procedures over short time periods are too low to be detectable, and may be nonexistent."

The Task Force also recommends the provision of care by an interdisciplinary team of thoracic surgeons working with radiologists, pulmonologists and oncologists. Such a team is "required to ensure decreased mortality from lung cancer outside of strict clinical trials in academic centers, including 0.5% operative mortality, and appropriate minimally invasive capabilities such as VATS."

The Task Force also indicated that it is "most desirable to create a program for lung cancer screening that also supports smoking cessation." Throughout the process there should be data gathered to "allow study of outcomes that are important for the practice of evidence-based medicine in the era of personalized health care."

In a summary statement of their new guidelines, the AATS recommended lung cancer screening for 3 distinct groups:

1) Level 1 evidence in favor of screening currently exists for North Americans between the ages of 55 and 79 with a 30 pack-year smoking history.

2) Lung cancer survivors are an extremely high risk group for developing a second lung cancer, and should be screened with LDCT starting 5 years after treatment.

3) Younger patients (age 50) with a 20 pack-year smoking history should be screened if they have an additional risk factor that produces a 5% risk of developing a lung cancer over the next 5 years. "At our current state of knowledge, that includes patients with documented radon exposure, occupational exposure, a lung cancer history in a first-degree relative if that cancer was recognized at a young age, COPD with an FEV1 of greater than 70%, and a tissue diagnosis of pulmonary fibrosis," according to the Task Force.

As costs are always of concern in proposing any new screening program, the Task Force discussed a recent estimate of the cost and benefit of annual lung cancer screening offered as a commercial insurance benefit for high risk Americans aged 50-64 years. That estimate found a screening cost of $1 per insured member per month in 2012 dollars.

The cost per life-year saved would be below $19,000. This compares favorably to cost per life-year saved in breast ($31,000 to $52,000), colon ($19,000 to $29,000), and cervical cancers ($50,000 to $75,000), the Task Force added.

The Task Force worked through an interdisciplinary consensus process, and its members were selected for their leadership in lung cancer screening, diagnosis, treatment, and follow-up of patient who have nodules and lung cancer. The fourteen individual members of the LCSSTF comprised: an epidemiologist, a pulmonologist, a pathologist, three medical oncologists, four thoracic radiologists, and four thoracic surgeons.

The idea of establishing a Task Force to create these consensus guidelines for the AATS was conceived by Dr. David J. Sugarbaker, chief of the Division of Thoracic Surgery at Brigham and Women’s Hospital. Other AATS members included on the Task Force are Dr. Shaf Keshavjee, director of the Toronto Lung Transplant Program at the University of Toronto, and Dr. Scott Swanson, professor of surgery at Brigham and Women’s Hospital.

The members of the Task Force reported no relevant disclosures.

SAN FRANCISCO – The American Association for Thoracic Surgery (AATS) Council approved new lung cancer screening guidelines at this year’s AATS Annual Meeting. A summary of the new "Guidelines for Lung Cancer Screening using Low Dose Computed Tomography (LDCT) Scans for Lung Cancer Survivors and Other High Risk Groups: Report of the AATS Lung Cancer Screening and Surveillance Task Force," was presented by Dr. Michael T. Jaklitsch.

Dr. Jaklitisch, a thoracic surgeon at Brigham and Women’s Hospital and an associate professor of surgery at Harvard Medical School, Boston, is the co-chair of the AATS Lung Cancer Screening and Surveillance Task Force along with Dr. Francine Jacobson, assistant professor of radiology at the hospital.

The AATS established the Lung Cancer Screening and Surveillance Task Force (LCSSTF) to create these guidelines for both smokers at high risk for lung cancer and lung cancer survivors in response to the publication of the National Lung Screening Trial (NLST), a randomized phase III trial, published in August 2011. The trial provided level 1 evidence that low-dose chest CT screening reduced lung cancer specific mortality by 20%.

Other societies such as the American Lung Association have also responded to the NLST trial with similar recommendations.

"Roughly 7 million out of 94 million current and former smokers in the United States meet the NLST criteria for highest risk screening. More than 75% of the positive screening tests resulted in additional testing, most frequently by repeat imaging. Less than 10% of the tests required an invasive procedure for further work-up," according to the Task Force.

The Task Force reported that the radiation exposure from LDCT appears to be negligible. They cited the fact that the average effective dose per scan in the NLST trial was 1.5 mSv and that the American Association of Physicists in Medicine, in a position statement on radiation risks from medical imaging procedures in December 2011, stated: "Risks of medical imaging at effective doses below 50 mSv for single procedures or 100 mSv for multiple procedures over short time periods are too low to be detectable, and may be nonexistent."

The Task Force also recommends the provision of care by an interdisciplinary team of thoracic surgeons working with radiologists, pulmonologists and oncologists. Such a team is "required to ensure decreased mortality from lung cancer outside of strict clinical trials in academic centers, including 0.5% operative mortality, and appropriate minimally invasive capabilities such as VATS."

The Task Force also indicated that it is "most desirable to create a program for lung cancer screening that also supports smoking cessation." Throughout the process there should be data gathered to "allow study of outcomes that are important for the practice of evidence-based medicine in the era of personalized health care."

In a summary statement of their new guidelines, the AATS recommended lung cancer screening for 3 distinct groups:

1) Level 1 evidence in favor of screening currently exists for North Americans between the ages of 55 and 79 with a 30 pack-year smoking history.

2) Lung cancer survivors are an extremely high risk group for developing a second lung cancer, and should be screened with LDCT starting 5 years after treatment.

3) Younger patients (age 50) with a 20 pack-year smoking history should be screened if they have an additional risk factor that produces a 5% risk of developing a lung cancer over the next 5 years. "At our current state of knowledge, that includes patients with documented radon exposure, occupational exposure, a lung cancer history in a first-degree relative if that cancer was recognized at a young age, COPD with an FEV1 of greater than 70%, and a tissue diagnosis of pulmonary fibrosis," according to the Task Force.

As costs are always of concern in proposing any new screening program, the Task Force discussed a recent estimate of the cost and benefit of annual lung cancer screening offered as a commercial insurance benefit for high risk Americans aged 50-64 years. That estimate found a screening cost of $1 per insured member per month in 2012 dollars.

The cost per life-year saved would be below $19,000. This compares favorably to cost per life-year saved in breast ($31,000 to $52,000), colon ($19,000 to $29,000), and cervical cancers ($50,000 to $75,000), the Task Force added.

The Task Force worked through an interdisciplinary consensus process, and its members were selected for their leadership in lung cancer screening, diagnosis, treatment, and follow-up of patient who have nodules and lung cancer. The fourteen individual members of the LCSSTF comprised: an epidemiologist, a pulmonologist, a pathologist, three medical oncologists, four thoracic radiologists, and four thoracic surgeons.

The idea of establishing a Task Force to create these consensus guidelines for the AATS was conceived by Dr. David J. Sugarbaker, chief of the Division of Thoracic Surgery at Brigham and Women’s Hospital. Other AATS members included on the Task Force are Dr. Shaf Keshavjee, director of the Toronto Lung Transplant Program at the University of Toronto, and Dr. Scott Swanson, professor of surgery at Brigham and Women’s Hospital.

The members of the Task Force reported no relevant disclosures.

SAN FRANCISCO – The American Association for Thoracic Surgery (AATS) Council approved new lung cancer screening guidelines at this year’s AATS Annual Meeting. A summary of the new "Guidelines for Lung Cancer Screening using Low Dose Computed Tomography (LDCT) Scans for Lung Cancer Survivors and Other High Risk Groups: Report of the AATS Lung Cancer Screening and Surveillance Task Force," was presented by Dr. Michael T. Jaklitsch.

Dr. Jaklitisch, a thoracic surgeon at Brigham and Women’s Hospital and an associate professor of surgery at Harvard Medical School, Boston, is the co-chair of the AATS Lung Cancer Screening and Surveillance Task Force along with Dr. Francine Jacobson, assistant professor of radiology at the hospital.

The AATS established the Lung Cancer Screening and Surveillance Task Force (LCSSTF) to create these guidelines for both smokers at high risk for lung cancer and lung cancer survivors in response to the publication of the National Lung Screening Trial (NLST), a randomized phase III trial, published in August 2011. The trial provided level 1 evidence that low-dose chest CT screening reduced lung cancer specific mortality by 20%.

Other societies such as the American Lung Association have also responded to the NLST trial with similar recommendations.

"Roughly 7 million out of 94 million current and former smokers in the United States meet the NLST criteria for highest risk screening. More than 75% of the positive screening tests resulted in additional testing, most frequently by repeat imaging. Less than 10% of the tests required an invasive procedure for further work-up," according to the Task Force.

The Task Force reported that the radiation exposure from LDCT appears to be negligible. They cited the fact that the average effective dose per scan in the NLST trial was 1.5 mSv and that the American Association of Physicists in Medicine, in a position statement on radiation risks from medical imaging procedures in December 2011, stated: "Risks of medical imaging at effective doses below 50 mSv for single procedures or 100 mSv for multiple procedures over short time periods are too low to be detectable, and may be nonexistent."

The Task Force also recommends the provision of care by an interdisciplinary team of thoracic surgeons working with radiologists, pulmonologists and oncologists. Such a team is "required to ensure decreased mortality from lung cancer outside of strict clinical trials in academic centers, including 0.5% operative mortality, and appropriate minimally invasive capabilities such as VATS."

The Task Force also indicated that it is "most desirable to create a program for lung cancer screening that also supports smoking cessation." Throughout the process there should be data gathered to "allow study of outcomes that are important for the practice of evidence-based medicine in the era of personalized health care."

In a summary statement of their new guidelines, the AATS recommended lung cancer screening for 3 distinct groups:

1) Level 1 evidence in favor of screening currently exists for North Americans between the ages of 55 and 79 with a 30 pack-year smoking history.

2) Lung cancer survivors are an extremely high risk group for developing a second lung cancer, and should be screened with LDCT starting 5 years after treatment.

3) Younger patients (age 50) with a 20 pack-year smoking history should be screened if they have an additional risk factor that produces a 5% risk of developing a lung cancer over the next 5 years. "At our current state of knowledge, that includes patients with documented radon exposure, occupational exposure, a lung cancer history in a first-degree relative if that cancer was recognized at a young age, COPD with an FEV1 of greater than 70%, and a tissue diagnosis of pulmonary fibrosis," according to the Task Force.

As costs are always of concern in proposing any new screening program, the Task Force discussed a recent estimate of the cost and benefit of annual lung cancer screening offered as a commercial insurance benefit for high risk Americans aged 50-64 years. That estimate found a screening cost of $1 per insured member per month in 2012 dollars.

The cost per life-year saved would be below $19,000. This compares favorably to cost per life-year saved in breast ($31,000 to $52,000), colon ($19,000 to $29,000), and cervical cancers ($50,000 to $75,000), the Task Force added.

The Task Force worked through an interdisciplinary consensus process, and its members were selected for their leadership in lung cancer screening, diagnosis, treatment, and follow-up of patient who have nodules and lung cancer. The fourteen individual members of the LCSSTF comprised: an epidemiologist, a pulmonologist, a pathologist, three medical oncologists, four thoracic radiologists, and four thoracic surgeons.

The idea of establishing a Task Force to create these consensus guidelines for the AATS was conceived by Dr. David J. Sugarbaker, chief of the Division of Thoracic Surgery at Brigham and Women’s Hospital. Other AATS members included on the Task Force are Dr. Shaf Keshavjee, director of the Toronto Lung Transplant Program at the University of Toronto, and Dr. Scott Swanson, professor of surgery at Brigham and Women’s Hospital.

The members of the Task Force reported no relevant disclosures.

SAN FRANCISCO - Pulmonary resection outcomes vary with respect to the kind of hospital in which the procedure is performed, particularly whether it is a teaching hospital, according to Dr. Castigliano M. Bhamidipati, of the University of Virginia Medical School, Charlottesville.

"In comparison to other hospitals, including general surgery teaching hospitals, cardiothoracic surgery teaching hospitals have lower morbidity and mortality," Dr. Bhamidipati said at the AATS annual meeting.

He and his colleagues examined the results of pulmonary resections performed at cardiothoracic (CT) teaching, general surgery (GS) teaching, nonsurgical (NS) teaching, and nonteaching (NT) hospitals.

The researchers evaluated the discharge records of nearly 500,000 adults who underwent either pneumonectomy, segmentectomy, lobar resections, or nonanatomic resections in an all-payer inpatient database for the time period between 2003 and 2009, according to Dr. Bhamidipati.

The hospital's teaching status as used in the study was determined by a linkage to the Association of American Medical Colleges’ Graduate Medical Education Tracking System.

The researchers examined patient demographics, risk factors, and hospital characteristics, and used multiple logistic regression models to examine in-hospital mortality, occurrence of any complications, and failure to rescue (death following a complication).

The mean annual percent of pulmonary resection volume among hospitals was CT (16%), GS (17%), NS (28%), and NT (39%).

The average age of pulmonary resection recipients among hospitals was similar, as were their mean number of comorbidities. The CT hospitals treated the smallest number of Medicare patients and the highest number of patients with Medicaid, a significant difference, said Dr. Bhamidipati.

He reported that the unadjusted mortality for all procedures was significantly lowest at the CT hospitals (CT: 2.6%; GS: 2.8%; NS: 3.4%; NT 3.6%).

Similarly, any complication was also least likely to occur at a CT hospital (CT: 20.5%, GS: 23.5%, NS: 24.6%, NT: 24.9%), he added.

Unadjusted procedural complications were found to be similar across hospitals, although pulmonary complications were significantly less likely to occur at CT hospitals compared with the others, according to Dr. Bhamidipati.

Following case-mix adjustment, the risk of having any complication after segmentectomy or nonanatomic resection was found to be significantly lower at CT hospitals than at the GS hospitals, he said.

In addition, among the pneumonectomy recipients, CT teaching status independently and significantly reduced the adjusted odds ratio (AOR) of failure to rescue by more than 25% compared with NS (AOR 0.34 vs. AOR 0.62).

Similarly, for the pneumonectomy patients, performance of the surgery at CT centers significantly lowered the AOR of death by more than 30% compared with GS hospitals (AOR 0.33 vs. AOR 0.69).

"These results support using CT hospital teaching status as an independent prognosticator of outcomes in pulmonary resections," concluded Dr. Bhamidipati.

Dr. Bhamidipati reported that he and his colleagues had no relevant disclosures.

SAN FRANCISCO - Pulmonary resection outcomes vary with respect to the kind of hospital in which the procedure is performed, particularly whether it is a teaching hospital, according to Dr. Castigliano M. Bhamidipati, of the University of Virginia Medical School, Charlottesville.

"In comparison to other hospitals, including general surgery teaching hospitals, cardiothoracic surgery teaching hospitals have lower morbidity and mortality," Dr. Bhamidipati said at the AATS annual meeting.

He and his colleagues examined the results of pulmonary resections performed at cardiothoracic (CT) teaching, general surgery (GS) teaching, nonsurgical (NS) teaching, and nonteaching (NT) hospitals.

The researchers evaluated the discharge records of nearly 500,000 adults who underwent either pneumonectomy, segmentectomy, lobar resections, or nonanatomic resections in an all-payer inpatient database for the time period between 2003 and 2009, according to Dr. Bhamidipati.

The hospital's teaching status as used in the study was determined by a linkage to the Association of American Medical Colleges’ Graduate Medical Education Tracking System.

The researchers examined patient demographics, risk factors, and hospital characteristics, and used multiple logistic regression models to examine in-hospital mortality, occurrence of any complications, and failure to rescue (death following a complication).

The mean annual percent of pulmonary resection volume among hospitals was CT (16%), GS (17%), NS (28%), and NT (39%).

The average age of pulmonary resection recipients among hospitals was similar, as were their mean number of comorbidities. The CT hospitals treated the smallest number of Medicare patients and the highest number of patients with Medicaid, a significant difference, said Dr. Bhamidipati.

He reported that the unadjusted mortality for all procedures was significantly lowest at the CT hospitals (CT: 2.6%; GS: 2.8%; NS: 3.4%; NT 3.6%).

Similarly, any complication was also least likely to occur at a CT hospital (CT: 20.5%, GS: 23.5%, NS: 24.6%, NT: 24.9%), he added.

Unadjusted procedural complications were found to be similar across hospitals, although pulmonary complications were significantly less likely to occur at CT hospitals compared with the others, according to Dr. Bhamidipati.

Following case-mix adjustment, the risk of having any complication after segmentectomy or nonanatomic resection was found to be significantly lower at CT hospitals than at the GS hospitals, he said.

In addition, among the pneumonectomy recipients, CT teaching status independently and significantly reduced the adjusted odds ratio (AOR) of failure to rescue by more than 25% compared with NS (AOR 0.34 vs. AOR 0.62).

Similarly, for the pneumonectomy patients, performance of the surgery at CT centers significantly lowered the AOR of death by more than 30% compared with GS hospitals (AOR 0.33 vs. AOR 0.69).

"These results support using CT hospital teaching status as an independent prognosticator of outcomes in pulmonary resections," concluded Dr. Bhamidipati.

Dr. Bhamidipati reported that he and his colleagues had no relevant disclosures.

SAN FRANCISCO - Pulmonary resection outcomes vary with respect to the kind of hospital in which the procedure is performed, particularly whether it is a teaching hospital, according to Dr. Castigliano M. Bhamidipati, of the University of Virginia Medical School, Charlottesville.

"In comparison to other hospitals, including general surgery teaching hospitals, cardiothoracic surgery teaching hospitals have lower morbidity and mortality," Dr. Bhamidipati said at the AATS annual meeting.

He and his colleagues examined the results of pulmonary resections performed at cardiothoracic (CT) teaching, general surgery (GS) teaching, nonsurgical (NS) teaching, and nonteaching (NT) hospitals.

The researchers evaluated the discharge records of nearly 500,000 adults who underwent either pneumonectomy, segmentectomy, lobar resections, or nonanatomic resections in an all-payer inpatient database for the time period between 2003 and 2009, according to Dr. Bhamidipati.

The hospital's teaching status as used in the study was determined by a linkage to the Association of American Medical Colleges’ Graduate Medical Education Tracking System.

The researchers examined patient demographics, risk factors, and hospital characteristics, and used multiple logistic regression models to examine in-hospital mortality, occurrence of any complications, and failure to rescue (death following a complication).

The mean annual percent of pulmonary resection volume among hospitals was CT (16%), GS (17%), NS (28%), and NT (39%).

The average age of pulmonary resection recipients among hospitals was similar, as were their mean number of comorbidities. The CT hospitals treated the smallest number of Medicare patients and the highest number of patients with Medicaid, a significant difference, said Dr. Bhamidipati.

He reported that the unadjusted mortality for all procedures was significantly lowest at the CT hospitals (CT: 2.6%; GS: 2.8%; NS: 3.4%; NT 3.6%).

Similarly, any complication was also least likely to occur at a CT hospital (CT: 20.5%, GS: 23.5%, NS: 24.6%, NT: 24.9%), he added.

Unadjusted procedural complications were found to be similar across hospitals, although pulmonary complications were significantly less likely to occur at CT hospitals compared with the others, according to Dr. Bhamidipati.

Following case-mix adjustment, the risk of having any complication after segmentectomy or nonanatomic resection was found to be significantly lower at CT hospitals than at the GS hospitals, he said.

In addition, among the pneumonectomy recipients, CT teaching status independently and significantly reduced the adjusted odds ratio (AOR) of failure to rescue by more than 25% compared with NS (AOR 0.34 vs. AOR 0.62).

Similarly, for the pneumonectomy patients, performance of the surgery at CT centers significantly lowered the AOR of death by more than 30% compared with GS hospitals (AOR 0.33 vs. AOR 0.69).

"These results support using CT hospital teaching status as an independent prognosticator of outcomes in pulmonary resections," concluded Dr. Bhamidipati.

Dr. Bhamidipati reported that he and his colleagues had no relevant disclosures.

SAN FRANCISCO - Pulmonary resection outcomes vary with respect to the kind of hospital in which the procedure is performed, particularly whether it is a teaching hospital, according to Dr. Castigliano M. Bhamidipati, of the University of Virginia Medical School, Charlottesville.

"In comparison to other hospitals, including general surgery teaching hospitals, cardiothoracic surgery teaching hospitals have lower morbidity and mortality," Dr. Bhamidipati said at the AATS annual meeting.

He and his colleagues examined the results of pulmonary resections performed at cardiothoracic (CT) teaching, general surgery (GS) teaching, nonsurgical (NS) teaching, and nonteaching (NT) hospitals.

The researchers evaluated the discharge records of nearly 500,000 adults who underwent either pneumonectomy, segmentectomy, lobar resections, or nonanatomic resections in an all-payer inpatient database for the time period between 2003 and 2009, according to Dr. Bhamidipati.

The hospital's teaching status as used in the study was determined by a linkage to the Association of American Medical Colleges’ Graduate Medical Education Tracking System.

The researchers examined patient demographics, risk factors, and hospital characteristics, and used multiple logistic regression models to examine in-hospital mortality, occurrence of any complications, and failure to rescue (death following a complication).

The mean annual percent of pulmonary resection volume among hospitals was CT (16%), GS (17%), NS (28%), and NT (39%).

The average age of pulmonary resection recipients among hospitals was similar, as were their mean number of comorbidities. The CT hospitals treated the smallest number of Medicare patients and the highest number of patients with Medicaid, a significant difference, said Dr. Bhamidipati.

He reported that the unadjusted mortality for all procedures was significantly lowest at the CT hospitals (CT: 2.6%; GS: 2.8%; NS: 3.4%; NT 3.6%).

Similarly, any complication was also least likely to occur at a CT hospital (CT: 20.5%, GS: 23.5%, NS: 24.6%, NT: 24.9%), he added.

Unadjusted procedural complications were found to be similar across hospitals, although pulmonary complications were significantly less likely to occur at CT hospitals compared with the others, according to Dr. Bhamidipati.

Following case-mix adjustment, the risk of having any complication after segmentectomy or nonanatomic resection was found to be significantly lower at CT hospitals than at the GS hospitals, he said.

In addition, among the pneumonectomy recipients, CT teaching status independently and significantly reduced the adjusted odds ratio (AOR) of failure to rescue by more than 25% compared with NS (AOR 0.34 vs. AOR 0.62).

Similarly, for the pneumonectomy patients, performance of the surgery at CT centers significantly lowered the AOR of death by more than 30% compared with GS hospitals (AOR 0.33 vs. AOR 0.69).

"These results support using CT hospital teaching status as an independent prognosticator of outcomes in pulmonary resections," concluded Dr. Bhamidipati.

Dr. Bhamidipati reported that he and his colleagues had no relevant disclosures.

SAN FRANCISCO - Pulmonary resection outcomes vary with respect to the kind of hospital in which the procedure is performed, particularly whether it is a teaching hospital, according to Dr. Castigliano M. Bhamidipati, of the University of Virginia Medical School, Charlottesville.

"In comparison to other hospitals, including general surgery teaching hospitals, cardiothoracic surgery teaching hospitals have lower morbidity and mortality," Dr. Bhamidipati said at the AATS annual meeting.

He and his colleagues examined the results of pulmonary resections performed at cardiothoracic (CT) teaching, general surgery (GS) teaching, nonsurgical (NS) teaching, and nonteaching (NT) hospitals.

The researchers evaluated the discharge records of nearly 500,000 adults who underwent either pneumonectomy, segmentectomy, lobar resections, or nonanatomic resections in an all-payer inpatient database for the time period between 2003 and 2009, according to Dr. Bhamidipati.

The hospital's teaching status as used in the study was determined by a linkage to the Association of American Medical Colleges’ Graduate Medical Education Tracking System.

The researchers examined patient demographics, risk factors, and hospital characteristics, and used multiple logistic regression models to examine in-hospital mortality, occurrence of any complications, and failure to rescue (death following a complication).

The mean annual percent of pulmonary resection volume among hospitals was CT (16%), GS (17%), NS (28%), and NT (39%).

The average age of pulmonary resection recipients among hospitals was similar, as were their mean number of comorbidities. The CT hospitals treated the smallest number of Medicare patients and the highest number of patients with Medicaid, a significant difference, said Dr. Bhamidipati.

He reported that the unadjusted mortality for all procedures was significantly lowest at the CT hospitals (CT: 2.6%; GS: 2.8%; NS: 3.4%; NT 3.6%).

Similarly, any complication was also least likely to occur at a CT hospital (CT: 20.5%, GS: 23.5%, NS: 24.6%, NT: 24.9%), he added.

Unadjusted procedural complications were found to be similar across hospitals, although pulmonary complications were significantly less likely to occur at CT hospitals compared with the others, according to Dr. Bhamidipati.

Following case-mix adjustment, the risk of having any complication after segmentectomy or nonanatomic resection was found to be significantly lower at CT hospitals than at the GS hospitals, he said.

In addition, among the pneumonectomy recipients, CT teaching status independently and significantly reduced the adjusted odds ratio (AOR) of failure to rescue by more than 25% compared with NS (AOR 0.34 vs. AOR 0.62).

Similarly, for the pneumonectomy patients, performance of the surgery at CT centers significantly lowered the AOR of death by more than 30% compared with GS hospitals (AOR 0.33 vs. AOR 0.69).

"These results support using CT hospital teaching status as an independent prognosticator of outcomes in pulmonary resections," concluded Dr. Bhamidipati.

Dr. Bhamidipati reported that he and his colleagues had no relevant disclosures.

SAN FRANCISCO - Pulmonary resection outcomes vary with respect to the kind of hospital in which the procedure is performed, particularly whether it is a teaching hospital, according to Dr. Castigliano M. Bhamidipati, of the University of Virginia Medical School, Charlottesville.

"In comparison to other hospitals, including general surgery teaching hospitals, cardiothoracic surgery teaching hospitals have lower morbidity and mortality," Dr. Bhamidipati said at the AATS annual meeting.

He and his colleagues examined the results of pulmonary resections performed at cardiothoracic (CT) teaching, general surgery (GS) teaching, nonsurgical (NS) teaching, and nonteaching (NT) hospitals.

The researchers evaluated the discharge records of nearly 500,000 adults who underwent either pneumonectomy, segmentectomy, lobar resections, or nonanatomic resections in an all-payer inpatient database for the time period between 2003 and 2009, according to Dr. Bhamidipati.

The hospital's teaching status as used in the study was determined by a linkage to the Association of American Medical Colleges’ Graduate Medical Education Tracking System.

The researchers examined patient demographics, risk factors, and hospital characteristics, and used multiple logistic regression models to examine in-hospital mortality, occurrence of any complications, and failure to rescue (death following a complication).

The mean annual percent of pulmonary resection volume among hospitals was CT (16%), GS (17%), NS (28%), and NT (39%).

The average age of pulmonary resection recipients among hospitals was similar, as were their mean number of comorbidities. The CT hospitals treated the smallest number of Medicare patients and the highest number of patients with Medicaid, a significant difference, said Dr. Bhamidipati.

He reported that the unadjusted mortality for all procedures was significantly lowest at the CT hospitals (CT: 2.6%; GS: 2.8%; NS: 3.4%; NT 3.6%).

Similarly, any complication was also least likely to occur at a CT hospital (CT: 20.5%, GS: 23.5%, NS: 24.6%, NT: 24.9%), he added.

Unadjusted procedural complications were found to be similar across hospitals, although pulmonary complications were significantly less likely to occur at CT hospitals compared with the others, according to Dr. Bhamidipati.

Following case-mix adjustment, the risk of having any complication after segmentectomy or nonanatomic resection was found to be significantly lower at CT hospitals than at the GS hospitals, he said.

In addition, among the pneumonectomy recipients, CT teaching status independently and significantly reduced the adjusted odds ratio (AOR) of failure to rescue by more than 25% compared with NS (AOR 0.34 vs. AOR 0.62).

Similarly, for the pneumonectomy patients, performance of the surgery at CT centers significantly lowered the AOR of death by more than 30% compared with GS hospitals (AOR 0.33 vs. AOR 0.69).

"These results support using CT hospital teaching status as an independent prognosticator of outcomes in pulmonary resections," concluded Dr. Bhamidipati.

Dr. Bhamidipati reported that he and his colleagues had no relevant disclosures.