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Disparities in Access to Thoracic Surgeons among Patients Receiving Lung Lobectomy in the United States

Objective: Lung lobectomy is the standard of care for early-stage lung cancer. Studies have suggested improved outcomes associated with lobectomy performed by specialized thoracic surgery providers. We hypothesized that disparities would exist regarding access to thoracic surgeons among patients rec...

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Autores principales: Halloran, Sean J., Alvarado, Christine E., Sarode, Anuja L., Jiang, Boxiang, Sinopoli, Jillian, Linden, Philip A., Towe, Christopher W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10047038/
https://www.ncbi.nlm.nih.gov/pubmed/36975426
http://dx.doi.org/10.3390/curroncol30030213
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author Halloran, Sean J.
Alvarado, Christine E.
Sarode, Anuja L.
Jiang, Boxiang
Sinopoli, Jillian
Linden, Philip A.
Towe, Christopher W.
author_facet Halloran, Sean J.
Alvarado, Christine E.
Sarode, Anuja L.
Jiang, Boxiang
Sinopoli, Jillian
Linden, Philip A.
Towe, Christopher W.
author_sort Halloran, Sean J.
collection PubMed
description Objective: Lung lobectomy is the standard of care for early-stage lung cancer. Studies have suggested improved outcomes associated with lobectomy performed by specialized thoracic surgery providers. We hypothesized that disparities would exist regarding access to thoracic surgeons among patients receiving lung lobectomy for cancer. Methods: The Premier Hospital Database was used to identify adult inpatients receiving lung lobectomy from 2009 to 2019. Patients were categorized as receiving their lobectomy from a thoracic surgeon, cardiovascular surgeon, or general surgeon. Sample-weighted multivariable analysis was performed to identify factors associated with provider type. Results: When adjusted for sampling, 121,711 patients were analyzed, including 71,709 (58.9%) who received lobectomy by a thoracic surgeon, 36,630 (30.1%) by a cardiovascular surgeon, and 13,373 (11.0%) by a general surgeon. Multivariable analysis showed that thoracic surgeon provider type was less likely with Black patients, Medicaid insurance, smaller hospital size, in the western region, and in rural areas. In addition, non-thoracic surgery specialty was less likely to perform minimally-invasive (MIS) lobectomy (cardiovascular OR 0.80, p < 0.001, general surgery OR 0.85, p = 0.003). Conclusions: In this nationally representative analysis, smaller, rural, non-teaching hospitals, and certain regions of the United States are less likely to receive lobectomy from a thoracic surgeon. Thoracic surgeon specialization is also independently associated with utilization of minimally invasive lobectomy. Combined, there are significant disparities in access to guideline-directed surgical care of patients receiving lung lobectomy.
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spelling pubmed-100470382023-03-29 Disparities in Access to Thoracic Surgeons among Patients Receiving Lung Lobectomy in the United States Halloran, Sean J. Alvarado, Christine E. Sarode, Anuja L. Jiang, Boxiang Sinopoli, Jillian Linden, Philip A. Towe, Christopher W. Curr Oncol Article Objective: Lung lobectomy is the standard of care for early-stage lung cancer. Studies have suggested improved outcomes associated with lobectomy performed by specialized thoracic surgery providers. We hypothesized that disparities would exist regarding access to thoracic surgeons among patients receiving lung lobectomy for cancer. Methods: The Premier Hospital Database was used to identify adult inpatients receiving lung lobectomy from 2009 to 2019. Patients were categorized as receiving their lobectomy from a thoracic surgeon, cardiovascular surgeon, or general surgeon. Sample-weighted multivariable analysis was performed to identify factors associated with provider type. Results: When adjusted for sampling, 121,711 patients were analyzed, including 71,709 (58.9%) who received lobectomy by a thoracic surgeon, 36,630 (30.1%) by a cardiovascular surgeon, and 13,373 (11.0%) by a general surgeon. Multivariable analysis showed that thoracic surgeon provider type was less likely with Black patients, Medicaid insurance, smaller hospital size, in the western region, and in rural areas. In addition, non-thoracic surgery specialty was less likely to perform minimally-invasive (MIS) lobectomy (cardiovascular OR 0.80, p < 0.001, general surgery OR 0.85, p = 0.003). Conclusions: In this nationally representative analysis, smaller, rural, non-teaching hospitals, and certain regions of the United States are less likely to receive lobectomy from a thoracic surgeon. Thoracic surgeon specialization is also independently associated with utilization of minimally invasive lobectomy. Combined, there are significant disparities in access to guideline-directed surgical care of patients receiving lung lobectomy. MDPI 2023-02-27 /pmc/articles/PMC10047038/ /pubmed/36975426 http://dx.doi.org/10.3390/curroncol30030213 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Halloran, Sean J.
Alvarado, Christine E.
Sarode, Anuja L.
Jiang, Boxiang
Sinopoli, Jillian
Linden, Philip A.
Towe, Christopher W.
Disparities in Access to Thoracic Surgeons among Patients Receiving Lung Lobectomy in the United States
title Disparities in Access to Thoracic Surgeons among Patients Receiving Lung Lobectomy in the United States
title_full Disparities in Access to Thoracic Surgeons among Patients Receiving Lung Lobectomy in the United States
title_fullStr Disparities in Access to Thoracic Surgeons among Patients Receiving Lung Lobectomy in the United States
title_full_unstemmed Disparities in Access to Thoracic Surgeons among Patients Receiving Lung Lobectomy in the United States
title_short Disparities in Access to Thoracic Surgeons among Patients Receiving Lung Lobectomy in the United States
title_sort disparities in access to thoracic surgeons among patients receiving lung lobectomy in the united states
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10047038/
https://www.ncbi.nlm.nih.gov/pubmed/36975426
http://dx.doi.org/10.3390/curroncol30030213
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