Certified thoracic surgeons in Japan: a national database survey on risk-adjusted mortality associated with lung resection

Purpose: We investigated the association between the number of certified general thoracic surgeons (GTSs) and the mortality after lung cancer surgery, based on the data from the National Clinical Database (NCD). Methods: We analyzed the characteristics and operative and postoperative data of 120,946 patients who underwent lung cancer surgery in one of the 905 hospitals in Japan. The number of GTSs in each hospital was categorized as 0, 1–2, or 3 or more. Multivariable analysis was applied to adjust the patients’ preoperative risk factors, as identified in a previous study. We calculated 95% confidence intervals (CI) for the mortality rate based on the odds ratios (ORs). Results: The patients’ characteristics were distributed almost uniformly regardless of the number of GTSs. Crude mortality according to the number of GTSs of 0, 1–2, or 3 or more was 0.9%, 0.8%, and 0.7%, respectively (p = 0.03). However, after adjustment, the ORs for 1–2 and 3 or more GTSs (reference: 0) were 0.86 (p = 0.23, 95% CI: 0.67–1.10) and 0.84 (p = 0.18, 95% CI: 0.64–1.09), respectively. The number of GTSs did not have a significant association with mortality. Similar results were observed for patients in the lobectomy cohort. Conclusion: Low surgical mortality was consistent, regardless of the number of GTSs in each hospital.