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The newspaper of The Johns Hopkins University March 10, 2008 | Vol. 37 No. 25
Risk of Surgery for Lung Cancer Is Lower at Teaching Hospitals

By Eric Vohr
Johns Hopkins Medicine

Patients cared for by hospitals with residents in training have a 17 percent less chance of dying after lung cancer surgery compared with patients undergoing surgery at nonteaching hospitals, according to results of a Johns Hopkins study published in the March issue of the Annals of Thoracic Surgery.

"There's a public perception that teaching hospitals can be dangerous places because of training issues, and concerns are frequently voiced by patients and echoed in the press regarding a fear of physicians in training practicing on them," said the lead author of the paper, Robert Meguid, a surgical resident at the Johns Hopkins School of Medicine. "The data from our study help refute these fears."

The investigators looked at data from 46,951 patients, ages 18 to 85, who underwent surgery for lung cancer at hospitals across the United States between 1998 and 2004. Operations ranged from small lung-segment removal to total lung removal.

The researchers tracked discharges and deaths, and compared the patient outcomes at four different types of facilities: hospitals without any physician training program, hospitals with a physician training program of any type, hospitals with general surgery training programs and hospitals with thoracic surgery training programs. They took into account factors such as age, gender and other illnesses of each patient, and they also took into consideration the number of each of the different types of lung cancer surgeries that each hospital performed.

"It has been well studied and reported that for complex procedures for high-risk patients, the more surgeries a hospital performs, the more likely the patient will survive the operation and hospitalization. This is the first study we know of which shows that teaching hospitals are factors associated with good patient outcome, independent of volume," Meguid said.

Lung cancer is the leading cause of cancer death among both males and females in the United States. In 2007, there were an estimated 213,380 new cases of lung cancer in the United States and 160,390 deaths related to the disease. Management of lung cancer has greatly improved over the past several decades. As a result, an increasing number of patients become eligible for lung resection procedures every year.

"Considerable efforts have been made to identify factors that may improve the quality of surgical care and associated outcomes for these high-risk patients," Meguid said. "Surgery for lung cancer at teaching hospitals may provide one source of quality improvement."

Additional researchers in the study, all from the Department of Surgery at Johns Hopkins, are Stephen Yang, chief of the Division of Thoracic Surgery, Malcolm Brock, Benjamin Brooke, David Chang and Timothy Sherwood. Sherwood has since left Johns Hopkins and is now at Mary Washington Hospital in Fredericksburg, Va.


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