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

被引:2
|
作者
Halloran, Sean J. J. [1 ]
Alvarado, Christine E. E. [2 ]
Sarode, Anuja L. L. [3 ]
Jiang, Boxiang [2 ]
Sinopoli, Jillian [2 ]
Linden, Philip a A. [2 ]
Towe, Christopher W. W. [2 ]
机构
[1] Univ Toledo, Dept Surg, Coll Med & Life Sci, Toledo, OH 43614 USA
[2] Univ Hosp Cleveland Med Ctr, Dept Surg, Div Thorac & Esophageal Surg, 11100 Euclid Ave Cleveland, Cleveland, OH 44106 USA
[3] Univ Hosp Cleveland Med Ctr, Dept Surg, UH RISES Res Surg Outcomes & Effectiveness, Cleveland, OH 44160 USA
关键词
thoracic surgery; lung lobectomy; disparities; access to care; LONG-TERM SURVIVAL; THORACOSCOPIC LOBECTOMY; RACIAL DISPARITIES; AMERICAN-COLLEGE; CANCER SURGERY; STAGE-I; OUTCOMES; REGIONALIZATION; CARE; SPECIALIZATION;
D O I
10.3390/curroncol30030213
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
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.
引用
收藏
页码:2801 / 2811
页数:11
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