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...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-02-01
|
| Series: | Current Oncology |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1718-7729/30/3/213 |
| _version_ | 1797612493867057152 |
|---|---|
| author | Sean J. Halloran Christine E. Alvarado Anuja L. Sarode Boxiang Jiang Jillian Sinopoli Philip A. Linden Christopher W. Towe |
| author_facet | Sean J. Halloran Christine E. Alvarado Anuja L. Sarode Boxiang Jiang Jillian Sinopoli Philip A. Linden Christopher W. Towe |
| author_sort | Sean J. Halloran |
| collection | DOAJ |
| 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, <i>p</i> < 0.001, general surgery OR 0.85, <i>p</i> = 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. |
| first_indexed | 2024-03-11T06:42:02Z |
| format | Article |
| id | doaj.art-98a414387b834910aa32804399d22893 |
| institution | Directory Open Access Journal |
| issn | 1198-0052 1718-7729 |
| language | English |
| last_indexed | 2024-03-11T06:42:02Z |
| publishDate | 2023-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Current Oncology |
| spelling | doaj.art-98a414387b834910aa32804399d228932023-11-17T10:30:49ZengMDPI AGCurrent Oncology1198-00521718-77292023-02-013032801281110.3390/curroncol30030213Disparities in Access to Thoracic Surgeons among Patients Receiving Lung Lobectomy in the United StatesSean J. Halloran0Christine E. Alvarado1Anuja L. Sarode2Boxiang Jiang3Jillian Sinopoli4Philip A. Linden5Christopher W. Towe6Department of Surgery, University of Toledo College of Medicine and Life Sciences, Toledo, OH 43614, USADivision of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue Cleveland, Cleveland, OH 44106, USAUH-RISES: Research in Surgical Outcomes and Effectiveness, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH 44160, USADivision of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue Cleveland, Cleveland, OH 44106, USADivision of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue Cleveland, Cleveland, OH 44106, USADivision of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue Cleveland, Cleveland, OH 44106, USADivision of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue Cleveland, Cleveland, OH 44106, USAObjective: 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, <i>p</i> < 0.001, general surgery OR 0.85, <i>p</i> = 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.https://www.mdpi.com/1718-7729/30/3/213thoracic surgerylung lobectomydisparitiesaccess to care |
| spellingShingle | Sean J. Halloran Christine E. Alvarado Anuja L. Sarode Boxiang Jiang Jillian Sinopoli Philip A. Linden Christopher W. Towe Disparities in Access to Thoracic Surgeons among Patients Receiving Lung Lobectomy in the United States Current Oncology thoracic surgery lung lobectomy disparities access to care |
| 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 | thoracic surgery lung lobectomy disparities access to care |
| url | https://www.mdpi.com/1718-7729/30/3/213 |
| work_keys_str_mv | AT seanjhalloran disparitiesinaccesstothoracicsurgeonsamongpatientsreceivinglunglobectomyintheunitedstates AT christineealvarado disparitiesinaccesstothoracicsurgeonsamongpatientsreceivinglunglobectomyintheunitedstates AT anujalsarode disparitiesinaccesstothoracicsurgeonsamongpatientsreceivinglunglobectomyintheunitedstates AT boxiangjiang disparitiesinaccesstothoracicsurgeonsamongpatientsreceivinglunglobectomyintheunitedstates AT jilliansinopoli disparitiesinaccesstothoracicsurgeonsamongpatientsreceivinglunglobectomyintheunitedstates AT philipalinden disparitiesinaccesstothoracicsurgeonsamongpatientsreceivinglunglobectomyintheunitedstates AT christopherwtowe disparitiesinaccesstothoracicsurgeonsamongpatientsreceivinglunglobectomyintheunitedstates |