Cardiopulmonary Testing Before Lung Resection: What Are Thoracic Surgeons Doing?

Adult Aged Decision Support Techniques Female Guideline Adherence Humans Lung / physiopathology Male Middle Aged Pneumonectomy Preoperative Care / methods Respiratory Function Tests / methods Retrospective Studies Risk Factors Surgeons / standards

Journal

The Annals of thoracic surgery
ISSN: 1552-6259
Titre abrégé: Ann Thorac Surg
Pays: Netherlands
ID NLM: 15030100R

Informations de publication

Date de publication:
10 2019
Historique:
received: 08 01 2019
revised: 02 04 2019
accepted: 14 04 2019
pubmed: 11 6 2019
medline: 21 1 2020
entrez: 11 6 2019
Statut: ppublish

Résumé

Cardiopulmonary assessment for lung resection is important for risk stratification, and the American College of Chest Physicians (ACCP) guidelines provide decision support. We ascertained the cardiopulmonary assessment practices of thoracic surgeons and determined whether they are guideline concordant. An anonymous survey was emailed to 846 thoracic surgeons who participate in The Society of Thoracic Surgeons General Thoracic Surgery Database. We analyzed survey responses by practice type (general thoracic [GT] versus cardiothoracic [CT]) and years in practice (0-9, 10-19, and ≥20) with the use of contingency tables. We compared adherence of survey responses with the guidelines. The response rate was 24.0% (n = 203). Most surgeons (n = 121, 59.6%) cited a predicted postoperative forced expiratory volume in 1 second or diffusing capacity of lung for carbon monoxide threshold of 40% for further evaluation. Experienced surgeons (≥20 years) were more likely to have a threshold that varies by surgical approach (31.3% versus 23.5% with 10-19 years of experience and 15.9% for 0-9 years of experience, P = .007). Overall, 52.2% refer patients with cardiovascular risk factors to cardiology and 42.9% refer patients with abnormal stress testing. CT surgeons were more likely to refer all patients to cardiology than GT surgeons (17.6% versus 2.4%, P < .001). Only one respondent (0.5%) was 100% adherent to the ACCP guidelines, and 4.4% and 45.8% were 75% and 50% adherent, respectively. Among thoracic surgeons, there is variation in preoperative cardiopulmonary assessment practices, with differences by practice type and years in practice, and marked discordance with the ACCP guidelines. Further study of guideline adherence linked to postoperative morbidity and mortality is warranted to determine whether adherence affects outcomes.

Sections du résumé

BACKGROUND
Cardiopulmonary assessment for lung resection is important for risk stratification, and the American College of Chest Physicians (ACCP) guidelines provide decision support. We ascertained the cardiopulmonary assessment practices of thoracic surgeons and determined whether they are guideline concordant.
METHODS
An anonymous survey was emailed to 846 thoracic surgeons who participate in The Society of Thoracic Surgeons General Thoracic Surgery Database. We analyzed survey responses by practice type (general thoracic [GT] versus cardiothoracic [CT]) and years in practice (0-9, 10-19, and ≥20) with the use of contingency tables. We compared adherence of survey responses with the guidelines.
RESULTS
The response rate was 24.0% (n = 203). Most surgeons (n = 121, 59.6%) cited a predicted postoperative forced expiratory volume in 1 second or diffusing capacity of lung for carbon monoxide threshold of 40% for further evaluation. Experienced surgeons (≥20 years) were more likely to have a threshold that varies by surgical approach (31.3% versus 23.5% with 10-19 years of experience and 15.9% for 0-9 years of experience, P = .007). Overall, 52.2% refer patients with cardiovascular risk factors to cardiology and 42.9% refer patients with abnormal stress testing. CT surgeons were more likely to refer all patients to cardiology than GT surgeons (17.6% versus 2.4%, P < .001). Only one respondent (0.5%) was 100% adherent to the ACCP guidelines, and 4.4% and 45.8% were 75% and 50% adherent, respectively.
CONCLUSIONS
Among thoracic surgeons, there is variation in preoperative cardiopulmonary assessment practices, with differences by practice type and years in practice, and marked discordance with the ACCP guidelines. Further study of guideline adherence linked to postoperative morbidity and mortality is warranted to determine whether adherence affects outcomes.

Identifiants

DOI: 10.1016/j.athoracsur.2019.04.057 PMID: 31181202
pubmed: 31181202
pii: S0003-4975(19)30735-0
doi: 10.1016/j.athoracsur.2019.04.057
pii:
doi:

Types de publication

Journal Article Multicenter Study Research Support, N.I.H., Extramural

Langues

eng

Sous-ensembles de citation

IM

Pagination

1006-1012

Subventions

Organisme : NCATS NIH HHS
ID : UL1 TR001860
Pays : United States
Organisme : NCATS NIH HHS
ID : KL2 TR001859
Pays : United States

Informations de copyright

Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Auteurs

James M Clark (JM)

Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento, California.

Angelica S Marrufo (AS)

Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento, California.

Benjamin D Kozower (BD)

Division of Cardiothoracic Surgery, Department of Surgery, Washington University, St Louis, Missouri.

Daniel J Tancredi (DJ)

Center for Healthcare Policy and Research, University of California, Davis Health, Sacramento, California.

Miriam Nuño (M)

Department of Public Health Sciences, University of California, Davis Health, Sacramento, California; Outcomes Research Group, Department of Surgery, University of California, Davis Health, Sacramento, California.

David T Cooke (DT)

Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento, California; Outcomes Research Group, Department of Surgery, University of California, Davis Health, Sacramento, California.

Brad H Pollock (BH)

Department of Public Health Sciences, University of California, Davis Health, Sacramento, California.

Patrick S Romano (PS)

Center for Healthcare Policy and Research, University of California, Davis Health, Sacramento, California; Outcomes Research Group, Department of Surgery, University of California, Davis Health, Sacramento, California; Department of Internal Medicine, University of California, Davis Health, Sacramento, California.

Lisa M Brown (LM)

Section of General Thoracic Surgery, Department of Surgery, University of California, Davis Health, Sacramento, California; Outcomes Research Group, Department of Surgery, University of California, Davis Health, Sacramento, California. Electronic address: lmbrown@ucdavis.edu.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Cardiopulmonary Testing Before Lung Resection:...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Cardiopulmonary Testing Before Lung Resection:...
questionsmedicales.fr › Sciences de l'information › Informatique › Informatique médicale › Applications de l'informatique médicale › Techniques d'aide à la décision › Cardiopulmonary Testing Before Lung Resection:...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Adhésion aux directives › Cardiopulmonary Testing Before Lung Resection:...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Cardiopulmonary Testing Before Lung Resection:...
questionsmedicales.fr › Appareil respiratoire › Poumon › Cardiopulmonary Testing Before Lung Resection:...
questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Adulte d'âge moyen › Cardiopulmonary Testing Before Lung Resection:...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie thoracique › Procédures de chirurgie pulmonaire › Pneumonectomie › Cardiopulmonary Testing Before Lung Resection:...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Soins périopératoires › Soins préopératoires › Cardiopulmonary Testing Before Lung Resection:...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Techniques de diagnostic respiratoire › Tests de la fonction respiratoire › Cardiopulmonary Testing Before Lung Resection:...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Cardiopulmonary Testing Before Lung Resection:...
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questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Personnel de santé › Médecins › Chirurgiens › Cardiopulmonary Testing Before Lung Resection:...