Influence of Surgical Subspecialty Training on in-Hospital Mortality for Gastrectomy and Colectomy Patients

Mark A. Callahan, Paul J. Christos, Heather T. Gold, Alvin I. Mushlin, John M. Daly, Timothy J. Eberlein, Carlos A. Pellegrani, Henry A. Pitt, Paris Tekkis, Martin S. Litwin, Marshall Z. Schwartz, Michael G. Sarr, Ronald V. Maier

Research output: Contribution to journalArticle

93 Citations (Scopus)

Abstract

Objective: This study examined the relationship of surgeon subspecialty training and interests to in-hospital mortality while controlling for both hospital and surgeon volume. Summary Background Data: The relationship between volume of surgical procedures and in-hospital mortality has been studied and shows an inverse relationship. Methods: A large Statewide Planning and Research Cooperative System was used to identify all 55,016 inpatients who underwent gastrectomy (n = 6434) or colectomy (n = 48,582) between January 1, 1998 and December 31, 2001. Surgical subspecialty training and interest was defined as surgeons who were members of the Society of Surgical Oncology (training/interest; n = 68) or the Society of Colorectal Surgery (training; n = 61) during the study period. The association of in-hospital mortality and subspecialty training/interest was examined using a logistic regression model, adjusting for demographics, comorbidifies, insurance status, and hospital and surgeon volume. Results: Overall mortality for colectomy patients was 4.6%; the adjusted mortality rate for subspecialty versus nonsubspecialty-trained surgeons was 2.4% versus 4.8%, respectively (adjusted odds ratio [OR] = 0.45; 95% confidence interval [CI] = 0.34, 0.60; P < 0.0001). Gastrectomy patients experienced an overall mortality rate of 8.4%; the adjusted mortality rate for patients treated by subspecialty trained surgeons was 6.5%, while the adjusted mortality rate for nonsubspecialty trained surgeons was 8.7% (adjusted OR = 0.70; 95% CI = 0.46, 1.08; P = 0.10). Conclusions: For gastrectomies and colectomies, risk-adjusted mortality is substantially lower when performed by subspecialty interested and trained surgeons, even after accounting for hospital and surgeon volume and patient characteristics. These findings may have implications for surgical training programs and for regionalization of complex surgical procedures.

Original languageEnglish (US)
Pages (from-to)629-639
Number of pages11
JournalAnnals of Surgery
Volume238
Issue number4
StatePublished - Oct 2003
Externally publishedYes

Fingerprint

Colectomy
Gastrectomy
Hospital Mortality
Mortality
Logistic Models
Odds Ratio
Confidence Intervals
Surgeons
Colorectal Surgery
Insurance Coverage
Inpatients
Demography
Education

ASJC Scopus subject areas

  • Surgery

Cite this

Callahan, M. A., Christos, P. J., Gold, H. T., Mushlin, A. I., Daly, J. M., Eberlein, T. J., ... Maier, R. V. (2003). Influence of Surgical Subspecialty Training on in-Hospital Mortality for Gastrectomy and Colectomy Patients. Annals of Surgery, 238(4), 629-639.

Influence of Surgical Subspecialty Training on in-Hospital Mortality for Gastrectomy and Colectomy Patients. / Callahan, Mark A.; Christos, Paul J.; Gold, Heather T.; Mushlin, Alvin I.; Daly, John M.; Eberlein, Timothy J.; Pellegrani, Carlos A.; Pitt, Henry A.; Tekkis, Paris; Litwin, Martin S.; Schwartz, Marshall Z.; Sarr, Michael G.; Maier, Ronald V.

In: Annals of Surgery, Vol. 238, No. 4, 10.2003, p. 629-639.

Research output: Contribution to journalArticle

Callahan, MA, Christos, PJ, Gold, HT, Mushlin, AI, Daly, JM, Eberlein, TJ, Pellegrani, CA, Pitt, HA, Tekkis, P, Litwin, MS, Schwartz, MZ, Sarr, MG & Maier, RV 2003, 'Influence of Surgical Subspecialty Training on in-Hospital Mortality for Gastrectomy and Colectomy Patients', Annals of Surgery, vol. 238, no. 4, pp. 629-639.
Callahan MA, Christos PJ, Gold HT, Mushlin AI, Daly JM, Eberlein TJ et al. Influence of Surgical Subspecialty Training on in-Hospital Mortality for Gastrectomy and Colectomy Patients. Annals of Surgery. 2003 Oct;238(4):629-639.
Callahan, Mark A. ; Christos, Paul J. ; Gold, Heather T. ; Mushlin, Alvin I. ; Daly, John M. ; Eberlein, Timothy J. ; Pellegrani, Carlos A. ; Pitt, Henry A. ; Tekkis, Paris ; Litwin, Martin S. ; Schwartz, Marshall Z. ; Sarr, Michael G. ; Maier, Ronald V. / Influence of Surgical Subspecialty Training on in-Hospital Mortality for Gastrectomy and Colectomy Patients. In: Annals of Surgery. 2003 ; Vol. 238, No. 4. pp. 629-639.
@article{a989b76eaa45419fb88579a3232b55a0,
title = "Influence of Surgical Subspecialty Training on in-Hospital Mortality for Gastrectomy and Colectomy Patients",
abstract = "Objective: This study examined the relationship of surgeon subspecialty training and interests to in-hospital mortality while controlling for both hospital and surgeon volume. Summary Background Data: The relationship between volume of surgical procedures and in-hospital mortality has been studied and shows an inverse relationship. Methods: A large Statewide Planning and Research Cooperative System was used to identify all 55,016 inpatients who underwent gastrectomy (n = 6434) or colectomy (n = 48,582) between January 1, 1998 and December 31, 2001. Surgical subspecialty training and interest was defined as surgeons who were members of the Society of Surgical Oncology (training/interest; n = 68) or the Society of Colorectal Surgery (training; n = 61) during the study period. The association of in-hospital mortality and subspecialty training/interest was examined using a logistic regression model, adjusting for demographics, comorbidifies, insurance status, and hospital and surgeon volume. Results: Overall mortality for colectomy patients was 4.6{\%}; the adjusted mortality rate for subspecialty versus nonsubspecialty-trained surgeons was 2.4{\%} versus 4.8{\%}, respectively (adjusted odds ratio [OR] = 0.45; 95{\%} confidence interval [CI] = 0.34, 0.60; P < 0.0001). Gastrectomy patients experienced an overall mortality rate of 8.4{\%}; the adjusted mortality rate for patients treated by subspecialty trained surgeons was 6.5{\%}, while the adjusted mortality rate for nonsubspecialty trained surgeons was 8.7{\%} (adjusted OR = 0.70; 95{\%} CI = 0.46, 1.08; P = 0.10). Conclusions: For gastrectomies and colectomies, risk-adjusted mortality is substantially lower when performed by subspecialty interested and trained surgeons, even after accounting for hospital and surgeon volume and patient characteristics. These findings may have implications for surgical training programs and for regionalization of complex surgical procedures.",
author = "Callahan, {Mark A.} and Christos, {Paul J.} and Gold, {Heather T.} and Mushlin, {Alvin I.} and Daly, {John M.} and Eberlein, {Timothy J.} and Pellegrani, {Carlos A.} and Pitt, {Henry A.} and Paris Tekkis and Litwin, {Martin S.} and Schwartz, {Marshall Z.} and Sarr, {Michael G.} and Maier, {Ronald V.}",
year = "2003",
month = "10",
language = "English (US)",
volume = "238",
pages = "629--639",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Influence of Surgical Subspecialty Training on in-Hospital Mortality for Gastrectomy and Colectomy Patients

AU - Callahan, Mark A.

AU - Christos, Paul J.

AU - Gold, Heather T.

AU - Mushlin, Alvin I.

AU - Daly, John M.

AU - Eberlein, Timothy J.

AU - Pellegrani, Carlos A.

AU - Pitt, Henry A.

AU - Tekkis, Paris

AU - Litwin, Martin S.

AU - Schwartz, Marshall Z.

AU - Sarr, Michael G.

AU - Maier, Ronald V.

PY - 2003/10

Y1 - 2003/10

N2 - Objective: This study examined the relationship of surgeon subspecialty training and interests to in-hospital mortality while controlling for both hospital and surgeon volume. Summary Background Data: The relationship between volume of surgical procedures and in-hospital mortality has been studied and shows an inverse relationship. Methods: A large Statewide Planning and Research Cooperative System was used to identify all 55,016 inpatients who underwent gastrectomy (n = 6434) or colectomy (n = 48,582) between January 1, 1998 and December 31, 2001. Surgical subspecialty training and interest was defined as surgeons who were members of the Society of Surgical Oncology (training/interest; n = 68) or the Society of Colorectal Surgery (training; n = 61) during the study period. The association of in-hospital mortality and subspecialty training/interest was examined using a logistic regression model, adjusting for demographics, comorbidifies, insurance status, and hospital and surgeon volume. Results: Overall mortality for colectomy patients was 4.6%; the adjusted mortality rate for subspecialty versus nonsubspecialty-trained surgeons was 2.4% versus 4.8%, respectively (adjusted odds ratio [OR] = 0.45; 95% confidence interval [CI] = 0.34, 0.60; P < 0.0001). Gastrectomy patients experienced an overall mortality rate of 8.4%; the adjusted mortality rate for patients treated by subspecialty trained surgeons was 6.5%, while the adjusted mortality rate for nonsubspecialty trained surgeons was 8.7% (adjusted OR = 0.70; 95% CI = 0.46, 1.08; P = 0.10). Conclusions: For gastrectomies and colectomies, risk-adjusted mortality is substantially lower when performed by subspecialty interested and trained surgeons, even after accounting for hospital and surgeon volume and patient characteristics. These findings may have implications for surgical training programs and for regionalization of complex surgical procedures.

AB - Objective: This study examined the relationship of surgeon subspecialty training and interests to in-hospital mortality while controlling for both hospital and surgeon volume. Summary Background Data: The relationship between volume of surgical procedures and in-hospital mortality has been studied and shows an inverse relationship. Methods: A large Statewide Planning and Research Cooperative System was used to identify all 55,016 inpatients who underwent gastrectomy (n = 6434) or colectomy (n = 48,582) between January 1, 1998 and December 31, 2001. Surgical subspecialty training and interest was defined as surgeons who were members of the Society of Surgical Oncology (training/interest; n = 68) or the Society of Colorectal Surgery (training; n = 61) during the study period. The association of in-hospital mortality and subspecialty training/interest was examined using a logistic regression model, adjusting for demographics, comorbidifies, insurance status, and hospital and surgeon volume. Results: Overall mortality for colectomy patients was 4.6%; the adjusted mortality rate for subspecialty versus nonsubspecialty-trained surgeons was 2.4% versus 4.8%, respectively (adjusted odds ratio [OR] = 0.45; 95% confidence interval [CI] = 0.34, 0.60; P < 0.0001). Gastrectomy patients experienced an overall mortality rate of 8.4%; the adjusted mortality rate for patients treated by subspecialty trained surgeons was 6.5%, while the adjusted mortality rate for nonsubspecialty trained surgeons was 8.7% (adjusted OR = 0.70; 95% CI = 0.46, 1.08; P = 0.10). Conclusions: For gastrectomies and colectomies, risk-adjusted mortality is substantially lower when performed by subspecialty interested and trained surgeons, even after accounting for hospital and surgeon volume and patient characteristics. These findings may have implications for surgical training programs and for regionalization of complex surgical procedures.

UR - http://www.scopus.com/inward/record.url?scp=10744233104&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=10744233104&partnerID=8YFLogxK

M3 - Article

C2 - 14530734

AN - SCOPUS:10744233104

VL - 238

SP - 629

EP - 639

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 4

ER -