Influence of Specialty Training and Trainee Involvement on Perioperative Outcomes of Esophagectomy

Abstract

Background Hospitals’ and surgeons’ volume-outcome relationship have been reported in several esophagectomy studies with an inverse association of mortality and volume. The purpose of our study was to evaluate the outcomes of esophagectomy in the United States relative to the surgeon's specialty. Methods This was a retrospective analysis using the American College of Surgeons National Surgical Quality Improvement Program database (2006 to 2013). All patients (18 years of age and older) who underwent esophagectomy were divided into 2 groups according to whether the operation was performed by a general surgeon (GS) or a cardiothoracic surgeon (CTS). A comparison of intraoperative and postoperative outcomes between the groups was conducted. The primary outcome was 30-day mortality. Secondary outcomes included overall and serious morbidity, discharge destination, and length of hospital stay. Results Of the 5,142 esophagectomies identified, 70.3% were performed by GS and 29.7% by CTS. Overall, CTS patients had significantly higher comorbidities and cancer rates (61% versus 53%). Both specialties preferred the transthoracic approach (59.41% for CTS versus 44.90% for GS). Trainee involvement was higher for CTS. There was no significant difference in mortality or overall morbidity. Patients operated on by GS had higher rates of wound infection, sepsis, shock, prolonged or unplanned intubation, and a longer hospital stay, whereas patients operated on by CTS had higher chance for bleeding and return to the operating room. Trainees’ involvement in esophagectomy was not associated with worse outcome. Conclusions Our study showed that a large number of esophagectomies in the United States are performed by GS, with the transthoracic approach being the most popular among both specialties. Trainees’ involvement in esophagectomy did not significantly affect patients’ outcomes. However CTS specialty was associated with lower incidence of infection and a shorter hospital stay.