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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