Efforts to improve the billing accuracy of robotic-assisted thoracic surgery through education, updated procedure cards, and electronic medical record system changes

Precise medical billing is essential for decreasing hospital liability, upholding environmental stewardship and ensuring fair costs for patients. We instituted a multifaceted approach to improve the billing accuracy of our robotic-assisted thoracic surgery programme by including an educational component, updating procedure cards and removing the auto-populating function of our electronic medical record. Overall, we saw significant improvements in both the number of inaccurate billing cases and, specifically, the number of cases that overcharged patients.

A Dedicated Path to Emergent Thoracic Surgery in COVID-19 Patients: An Italian Institution Protocol

The outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic pointed out that the need to ensure emergent surgery in patients positive for infection is no longer hypothetical. Among emergency procedures, thoracic surgical operations are frequent. A standardized surgical pathway is mandatory to achieve effective and safe management of this subset of patients. We briefly present the protocol adopted by our thoracic surgery division.

154 compared to 54 mmol per liter of sodium in intravenous maintenance fluid therapy for adult patients undergoing major thoracic surgery (TOPMAST): a single-center randomized controlled double-blind trial

PURPOSE

To determine the effects of the sodium content of maintenance fluid therapy on cumulative fluid balance and electrolyte disorders.

METHODS

We performed a randomized controlled trial of adults undergoing major thoracic surgery, randomly assigned (1:1) to receive maintenance fluids containing 154 mmol/L (Na154) or 54 mmol/L (Na54) of sodium from the start of surgery until their discharge from the ICU, the occurrence of a serious adverse event or the third postoperative day at the latest. Investigators, caregivers and patients were blinded to the treatment. Primary outcome was cumulative fluid balance. Electrolyte disturbances were assessed as secondary endpoints, different adverse events and physiological markers as safety and exploratory endpoints.

FINDINGS

We randomly assigned 70 patients; primary outcome data were available for 33 and 34 patients in the Na54 and Na154 treatment arms, respectively. Estimated cumulative fluid balance at 72 h was 1369 mL (95% CI 601-2137) more positive in the Na154 arm (p < 0.001), despite comparable non-study fluid sources. Hyponatremia < 135 mmol/L was encountered in four patients (11.8%) under Na54 compared to none under Na154 (p = 0.04), but there was no significantly more hyponatremia < 130 mmol/L (1 versus 0; p = 0.31). There was more hyperchloremia > 109 mmol/L under Na154 (24/35 patients, 68.6%) than under Na54 (4/34 patients, 11.8%) (p < 0.001). The treating clinicians discontinued the study due to clinical or radiographic fluid overload in six patients receiving Na154 compared to one patient under Na54 (excess risk 14.2%; 95% CI - 0.2-30.4%, p = 0.05).

CONCLUSIONS

In adult surgical patients, sodium-rich maintenance solutions were associated with a more positive cumulative fluid balance and hyperchloremia; hypotonic fluids were associated with mild and asymptomatic hyponatremia.

ERS/EACTS statement on the management of malignant pleural effusions

Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomized clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature. Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE. The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.Management options for malignant pleural effusions have advanced over the past decade, with high-quality randomized trial evidence informing practice in many areas. However, uncertainties remain and further research is required http://ow.ly/rNt730jOxOS.

The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Database Program - Two Decades of Quality Assurance Data

Over two decades, the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) cardiac surgery database program has evolved from a single state-based database to a national clinical quality registry program and is now the most comprehensive cardiac surgical registry in Australia. We report the current structure and governance of the program and its key activities.

Effectiveness of Percutaneous Intradiscal Decompression Therapy in Thoracic Disc Herniation

Aims

Although there have been many studies about lumbar and cervical ablation procedures, few studies have been performed in the thoracic region. To evaluate the clinical results of a percutaneous disc decompression device in patients with radicular symptoms and/or dorsal pain due to thoracic disc herniation.

Methods

Eleven patients with thoracic disc herniation and/or degenerative discs (all in T10-T11, or T11-T12 levels) who did not respond to conservative treatments were undergoing ablation and compression procedures. Pain and radicular symptoms consistent with the thoracolumbar region were confirmed via abnormal magnetic resonance imaging findings after detailed anamnesis and physical examination. All patients were evaluated before and 1, 3, 6, and 12 months after treatment using the visual analog scale score. The patient satisfaction scale was used to evaluate the level of patient satisfaction at the end of the treatment at 12 months.

Results

The median visual analog scale score was 7.00±0.45 points before treatment and 2.73±0.65 points at 12 months post-procedure and were statistically significant (p<0.001). The results of pairwise comparisons using the Bonferroni Corrected Wilcoxon Signed-Rank test showed that there were statistically significant differences. The mean visual analog scale score at the beginning (7.00±0.45) was significantly higher than the mean score of other months. Postoperative improvement was significant with a 99% confidence interval. No complications that may cause permanent damage occurred.

Conclusion

Percutaneous disc decompression is an effective and safe procedure to treat pain caused by lower thoracic intervertebral disc disease, which did not respond to conservative treatments.

Self-Appraised Readiness of Senior and Graduating General Surgery Residents to Perform Thoracic Surgery

OBJECTIVE

General surgeons perform up to 50% of noncardiac thoracic surgery (TS). Although data show consistent TS case volume during general surgery (GS) residency it is unknown whether this operative trend will persist given potentially limited subspecialty exposure. We sought to determine if certain aspects of residency programs and resident characteristics were associated with trainees' perceived comfort in performing certain basic TS procedures.

DESIGN

An anonymous survey was distributed to GS residents regarding program characteristics, presence of a TS residency, and intent to pursue thoracic surgical training, and estimated case volumes of individual procedures. Comfort levels for performing video-assisted thoracoscopic surgical (VATS) procedures, open lobectomy, elective thoracotomy, and sternotomy were attained through a 5-point Likert-type scale.

SETTING

This survey was administered at 50 training programs with responses recorded via an online form.

PARTICIPANTS

Fourth- and fifth-year GS residents in the United States.

RESULTS

Of 272 respondents 58% were fourth-year residents, 62% of residents trained at university-affiliated programs, and 64% reported a TS residency program at their institution and 16% stated intent to pursue TS. Fifth-year residents performed significantly more cases than fourth-year residents despite no difference in median comfort levels. Residents intending to pursue TS performed significantly more cases and were more comfortable performing a thoracotomy, sternotomy, VATS wedge resection/biopsy, and VATS decortication/pleurodesis (p = 0.044, <0.001, 0.045, 0.025). No characteristics were associated with comfort performing a lobectomy via thoracoscopic or open (thoracotomy) approaches.

CONCLUSION

Most senior or graduating GS residents state they are comfortable performing certain thoracic procedures with those pursuing additional thoracic surgical training more comfortable overall. No characteristics were associated with comfort performing a lobectomy. These findings may advise residency curriculum design to ensure continued thoracic surgical exposure and recommend against non-fellowship trained surgeons performing a pulmonary lobectomy.

Start-up of a Cardiology Day Hospital: Activity, Quality Care and Cost-effectiveness Analysis of the First Year of Operation

INTRODUCTION AND OBJECTIVES

The cardiology day hospital (CDH) is an alternative to hospitalization for scheduled cardiological procedures. The aims of this study were to analyze the activity, quality of care and the cost-effectiveness of a CDH.

METHODS

An observational descriptive study was conducted of the health care activity during the first year of operation of DHHA. The quality of care was analyzed through the substitution rate (outpatient procedures), cancellation rates, complications, and a satisfaction survey. For cost-effectiveness, we calculated the economic savings of avoided hospital stays.

RESULTS

A total of 1646 patients were attended (mean age 69 ± 15 years, 60% men); 2550 procedures were scheduled with a cancellation rate of 4%. The most frequently cancelled procedure was electrical cardioversion. The substitution rate for scheduled invasive procedures was 66%. Only 1 patient required readmission after discharge from the CDH due to heart failure. Most surveyed patients (95%) considered the care received in the CDH to be good or very good. The saving due to outpatient-converted procedures made possible by the CDH was € 219 199.55, higher than the cost of the first year of operation.

CONCLUSIONS

In our center, the CDH allowed more than two thirds of the invasive procedures to be performed on an outpatient basis, while maintaining the quality of care. In the first year of operation, the expenses due to its implementation were offset by a significant reduction in hospital admissions.

Revision of Immediate Post-Open Heart Surgery Education for Critical Care RNs

Responding to the complex nature of critical care is imperative, as extensive clinical judgment is required during those vital moments when patients are experiencing complications related to open heart surgery, post-vessel bypass, or valve replacement. Critical care registered nurses must rely on evidence-based foundational knowledge and skills particular to cardiovascular pathophysiology, hemodynamic monitoring, and medications. This article reports on the critical care educator's revision of the immediate post-open heart surgery curriculum. Mixed educational methods within the plan were foundational to develop clinicians for competent care of these complex patients (within the first 8 hours). The revision included experiential learning and learner centeredness to bolster the learner's confidence, reduce the time to competence, and, most important, ensure positive patient outcomes. Kirkpatrick's classic four-level model provided the framework for evaluation. Lessons learned were discussed following the program initiation.

Perioperative diabetes care: room for improving the person centredness

AIMS

Person centredness is an important principle for delivering high-quality diabetes care. In this study, we assess the level of person centredness of current perioperative diabetes care.

METHODS

We conducted a survey in six Dutch hospitals, among 690 participants with diabetes who underwent major abdominal, cardiac or large-joint orthopaedic surgery. The survey included questions regarding seven dimensions of person-centred perioperative diabetes care.

RESULTS

Complete data were obtained from 298 participants. The survey scores were low for many of the dimensions of person centredness. The dimensions 'information', 'patient involvement' and 'coordination and integration of care' had the lowest scores. Only half the participants had received information about perioperative diabetes treatment, and approximately one-third had received information about the effect of surgery on blood glucose values, target glucose values and glucose measurement times. Similarly, half the participants had an opportunity to ask questions preoperatively, and only one-third of the participants felt involved in the decision-making regarding diabetes treatment. Most participants knew neither the caregiver in charge of perioperative diabetes treatment nor whom to contact in case of diabetes-related problems during their hospital stay.

CONCLUSIONS

Current perioperative diabetes care is characterized by a lack of patient information and limited patient involvement. These results indicate that there is ample room for improving the person centredness of perioperative diabetes care.

Identifying areas of weakness in thoracic surgery residency training: a comparison of the perceptions of residents and program directors

OBJECTIVE

To identify core thoracic surgery procedures that require increased emphasis during thoracic surgery residency for residents to achieve operative independence and to compare the perspectives of residents and program directors in this regard.

METHODS

A modified Delphi process was used to create a survey that was distributed electronically to all Canadian thoracic surgery residents (12) and program directors (8) addressing the residents' ability to perform 19 core thoracic surgery procedures independently after the completion of residency. Residents were also questioned about the adequacy of their operative exposure to these 19 procedures during their residency training. A descriptive summary including calculations of frequencies and proportions was conducted. The perceptions of the 2 groups were then compared using the Fisher exact test employing a Bonferroni correction. The relationship between residents' operative exposure and their perceived operative ability was explored in the same fashion.

RESULTS

The response rate was 100% for residents and program directors. No statistical differences were found between residents' and program directors' perceptions of residents' ability to perform the 19 core procedures independently. Both groups identified lung transplantation, first rib resection, and extrapleural pneumonectomy as procedures for which residents were not adequately prepared to perform independently. Residents' subjective ratings of operative exposure were in good agreement with their reported operative ability for 13 of 19 procedures.

CONCLUSION

This study provides new insight into the perceptions of thoracic surgery residents and their program directors regarding operative ability. This study points to good agreement between residents and program directors regarding residents' surgical capabilities. This study provides information regarding potential weaknesses in thoracic surgery training, which may warrant an examination of the curricula of existing programs as well as a reconsideration of what the scope of practice of a general thoracic surgeon should entail.

Clean technique for prolonged nonsurvival cardiothoracic surgery in swine (Sus scrofa)

Laboratory animal regulations provide little guidance regarding duration of nonsurvival surgery requiring aseptic technique. We hypothesized that swine would experience no sepsis during nonsurvival cardiothoracic surgery accomplished by using clean technique and lasting 8 h or less. Incision sites of 5 male farm pigs (Sus scrofa) were shaved and then cleaned with alcohol and povidone-iodine. The surgeon wore sterile gloves, clean scrubs, and hair bonnet; assistants wore clean scrubs and nonsterile gloves; most instruments were autoclaved. A median sternotomy incision was used for thoracic cavity exposure, and the skull was exposed to allow induction of brain death. Heart rate, body temperature, and blood samples were obtained before surgery (0 h; baseline) and at 2, 4, 5 or 6, and 7 or 8 h thereafter. Statistical analysis by t-tests showed that heart rate was unchanged and body temperature increased after the 0-h (baseline) time point. Aerobic blood cultures were negative except for 2 samples that were positive for coagulase-negative Staphylococcus spp. at 4 h. RBC, Hgb, and Hct levels were decreased at 2 and 4 h, but WBC and platelets were unchanged. Other alterations included decreased glucose (at 7 or 8 h), increased BUN (at 5 or 6 h and 7 or 8 h) and creatinine (at 5 or 6 h), decreased Na(+) and Ca and increased K(+) (most time points), decreased total protein and albumin (most time points), and decreased globulin (at 7 or 8 h). Liver enzymes and bilirubin typically were unchanged, and cholesterol consistently was decreased. Together our results indicate a lack of sepsis for 8 h or less in pigs undergoing cardiothoracic surgery by using clean technique. These findings provide new and specific data regarding the use of aseptic technique during prolonged nonsurvival surgeries.

The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups

OBJECTIVE

Lung cancer is the leading cause of cancer death in North America. Low-dose computed tomography screening can reduce lung cancer-specific mortality by 20%.

METHOD

The American Association for Thoracic Surgery created a multispecialty task force to create screening guidelines for groups at high risk of developing lung cancer and survivors of previous lung cancer.

RESULTS

The American Association for Thoracic Surgery guidelines call for annual lung cancer screening with low-dose computed tomography screening for North Americans from age 55 to 79 years with a 30 pack-year history of smoking. Long-term lung cancer survivors should have annual low-dose computed tomography to detect second primary lung cancer until the age of 79 years. Annual low-dose computed tomography lung cancer screening should be offered starting at age 50 years with a 20 pack-year history if there is an additional cumulative risk of developing lung cancer of 5% or greater over the following 5 years. Lung cancer screening requires participation by a subspecialty-qualified team. The American Association for Thoracic Surgery will continue engagement with other specialty societies to refine future screening guidelines.

CONCLUSIONS

The American Association for Thoracic Surgery provides specific guidelines for lung cancer screening in North America.

Do new thoracic surgeons feel ready to operate? Self-reported comfort level of thoracic surgery trainees and junior thoracic surgeons with core thoracic surgery procedures

OBJECTIVE

To evaluate and compare self-reported surgical experience and comfort levels of Canadian thoracic surgery trainees and junior thoracic surgeons (<5 years in practice) with respect to core thoracic surgery procedures.

METHODS

A modified Delphi process was used to create a survey that was distributed electronically to all Canadian thoracic surgery residents and newly graduated thoracic surgeons. A descriptive summary, including calculation of frequencies, means, proportions, and standard deviations was conducted. Associations between reported experience and comfort level for residents and surgeons were explored separately using the Pearson product moment correlation. The differences between resident and junior surgeons' rating of experience and comfort for each procedure were explored using Fisher exact tests.

RESULTS

The response rates were 50% for residents and 85% for staff. Adequate or better experience was reported by residents for 9 of 18 core thoracic surgical procedures and by staff for 10 of 18 procedures. A significant difference in self-reported experience level was found between groups for only 1 of 18 procedures. Staff reported that they would confidently perform 7 of 18 procedures independently at the end of their training. The mean resident response did not reach this level of comfort for any of the 18 procedures. Eight of 16 staff had completed extra training, primarily for personal interest, whereas 4 of 6 residents were planning on further training because of job market factors.

DISCUSSION

The results of this study help to characterize the comfort levels of thoracic trainees and new attending thoracic surgeons with core thoracic procedures and might assist training programs in identifying and improving areas of weakness.

Has Microsoft left behind risk modeling in cardiac and thoracic surgery?

This concept paper examines a number of key areas central to quality and risk assessment in cardiac surgery. The effect of surgeon and institutional factors with regard to outcomes in cardiac surgery is utilized to demonstrate the need to sub analyze cardiac surgeons performance in a more sophisticated manner than just operation type and patient risk factors, as in current risk models. By utilizing the mathematical/engineering concept of Fourier analysis in the breakdown of cardiac surgical results the effects of each of the core components that makes up the care package of a patient's experiences are examined. The core components examined include: institutional, regional, patient, and surgeon effects. The limitations of current additive (Parsonnet, Euroscore) and logistic (Euroscore, SouthernThoracic Society) regression risk analysis techniques are discussed. The inadequacy of current modeling techniques is demonstrated via the use of known medical formula for calculating flow in the internal mammary artery and the calculation of blood pressure. By examining the fundamental limitations of current risk analysis techniques a new technique is proposed that embraces modern software computer technology via the use of structured query language.

Pitfalls in penetrating thoracic trauma (lessons we learned the hard way...)

The majority of patients with penetrating thoracic trauma are managed non-operatively. Those requiring surgery usually go to theater with physiological instability. The critical condition of these patients coupled with the rarity of penetrating thoracic trauma in most European countries makes their surgical management challenging for the occasional trauma surgeon, who is usually trained as a general surgeon. Most general surgeons have a general knowledge of basic cardiothoracic operative surgery, knowledge originating from their training years and possibly enhanced by reading operative surgery textbooks. Unfortunately, the details included in most of these books are not extensive enough to provide him with enough armamentaria to tackle the difficult case. In this anatomical region, their operative dexterity and knowledge cannot be compared to that of their cardiothoracic colleagues, something that is taken for granted in their cardiothoracic trauma textbooks. Techniques that are considered basic and easy by the cardiothoracic surgeons can be unfamiliar and difficult to general surgeons. Knowing the danger points and the pitfalls that will be encountered in cardiothoracic trauma surgery will help them to avoid intraoperative errors and improve patient outcome. The purpose of this manuscript is to highlight the commonly encountered pitfalls by trauma surgeons operating on penetrating trauma to the chest.

NHS goes to the PROMS

Sir Bruce Keogh has been credited for encouraging cardiac surgeons to publish their results. Now, as the medical director of the NHS, he’s turning his attention to other specialties. Nick Timmins investigates

Standards for Thoracic Surgical Oncology in a Single-Payer Healthcare System

Through systematic literature review and a consensus-based approach from an expert panel, standards on the organization for delivering thoracic cancer surgery in a single-payer healthcare environment were developed. Thirty-two studies and six organizational reports were identified. Results from 32 studies showed a trend toward higher volumes and improved patient outcomes, and six consensus reports provided recommendations on thoracic care standards. Thoracic surgical oncology standards in a single-payer healthcare system were developed. The benefits associated with the implementation of thoracic cancer surgery standards should result in increased regionalization of care, improved processes of care, and better patient outcomes.

Estimating the potential impact of regionalizing health care delivery based on volume standards versus risk-adjusted mortality rate

OBJECTIVE

To examine whether basing regionalization on risk-adjusted mortality would lead to better population outcomes than basing regionalization on procedure volume.

DATA SOURCE

We used secondary data from the California State Inpatient Database obtained from the Healthcare Costs and Utilization Project.

STUDY DESIGN

A population-based retrospective cohort study of 243 thousand patients who underwent either abdominal aortic aneurysm surgery, coronary artery bypass surgery or coronary angioplasty between 1998 and 2000 in California. Four regionalization strategies were compared: (i) selective referral to high-quality hospitals; (ii) selective referral to high-volume hospitals; (iii) selective avoidance of low-quality hospitals; (iv) selective avoidance of low-volume hospitals.

PRINCIPAL FINDINGS

Selective referral to high volume centers would be only moderately effective (2-20% relative reduction in mortality) and extremely disruptive (70-99% reduction in the number of hospitals treating these conditions). Selective referral to high quality centers was estimated to result in dramatic reduction in mortality (50%) but would also be highly disruptive with greater than 80% of the patients re-directed to high quality centers. Selective avoidance of low volume hospitals would not improve mortality, whereas selective avoidance of low quality hospitals was estimated to result in a small improvement in overall mortality (2-6%) while causing relatively minor disruptions in patient referral patterns.

CONCLUSION

Efforts to use volume standards as the basis for evidence-based hospital referrals should be re-evaluated by all stake-holders before promoting further efforts to regionalize health care delivery using volume cutoffs.

[Evaluation of thoracic surgical practice. The impact of specialisation and the effect of volume on the results of cancer treatment: resectability, post-operative mortality, and long-term survival]

INTRODUCTION AND METHODS

The impact of the volume of activity and the specialisation of the surgeon and the hospital on the quality of health care for patients with non-small cell lung cancer (NSCLC) was evaluated from the publications over the last 20 years.

RESULTS

The statistics, based mainly on administrative data, identified a significant decrease in post operative mortality (5 out of 7 studies) and improved long-term survival (2 out of 3 studies) in establishments undertaking large numbers of lung resections. The threshold for defining high volume groups varied from study to study (from 28 to 128 procedures per year). The same tendency was seen among the surgeons where specialisation in thoracic surgery led to higher levels of resectability and parenchymal preservation.

CONCLUSIONS

These results should be interpreted with caution on account of the nature of the data and the methodology employed. A certification of referral centres, validated by the French Thoracic and Cardiovascular Surgical Society, based on the training, level of activity in cancer surgery, and the infrastructure of the hospital should lead to a more even standard of care for patients with NSCLC.

[The connection between hospital volume and outcome in thorax surgery]

A review of current literature with respect to a possible correlation among hospital volume, caseload and outcome of thoracic and cardiovascular surgery supports quite convincingly the theory that, from a probability point of view, the combination of high-volume hospitals with high-volume surgeons produces the best results. During the last decade, thoracic and cardiovascular surgery has to a certain degree been centralized in Denmark, reducing the number of public centres to the five university hospitals. None of these centres is low-volume, and two are high-volume hospitals.

Mitral repair best practice: proposed standards

OBJECTIVES

To define best practice standards for mitral valve repair surgery.

DESIGN

Development of standards for process and outcome by consensus.

SETTING

Multidisciplinary panel of surgeons, anaesthetists, and cardiologists with interests and expertise in caring for patients with severe mitral regurgitation.

MAIN OUTCOME MEASURES

Standards for best practice were defined including the full spectrum of multidisciplinary aspects of care.

RESULTS

19 criteria for best practice were defined including recommendations on surgical training, intraoperative transoesophageal echocardiography, surgery for atrial fibrillation, audit, and cardiology and imaging issues.

CONCLUSIONS

Standards for best practice in mitral valve repair were defined by multidisciplinary consensus. This study gives centres undertaking mitral valve repair an opportunity to benchmark their care against agreed standards that are challenging but achievable. Working towards these standards should act as a stimulus towards improvements in care.

[Introduction of electronic monitoring increased interest for quality work. Nine-year-registration at Hjartcentrum indicates improved medical results]

Medical, administrative and economic data in a cardio-thoracic unit were followed for 9 years in an extensive monitoring system. Several changes in the practice could be observed. There was a general improvement in total quality factors seen as decreased complication rate especially in normal patients, a change in case mix towards older and more complicated patients and a decrease in the costs. The monitoring was a prerequisite for following, initiating and controlling changes. The article is published in English in Interactive Cardiovascular and Thoracic Surgery.

The practice of thoracic surgery in Canada

The objective of the consensus conference of the Canadian Association of Thoracic Surgeons (CATS) was to define the scope of thoracic surgery practice in Canada, to develop standards of practice, to define training and resource requirements for the practice of thoracic surgery in Canada and to determine appropriate waiting times for thoracic surgery care. A meeting of the CATS membership was held in September 2001 to address issues facing thoracic surgeons practising in Canada. The discussion was facilitated by an expert panel of surgeons and supplemented by a survey. At the end of the meeting, consensus was reached by the membership regarding the issues outline above. The membership agreed that the scope of practice includes diagnosis and management of conditions of the lungs, mediastinum, pleura and foregut. They agreed that appropriate training in thoracic surgery included completion and certification in general or cardiac surgery prior to completing a 2-year program in thoracic surgery. The membership supported the Canadian Society of Surgical Oncology recommendations for management of cancer patients that new patients should be seen within 2 weeks of referral and cancer therapy initiated within 2 weeks of consultation. Thoracic surgical care is best delivered by 2 or 3 fully certified thoracic surgeons, in regional centres linked to a cancer centre and trauma unit. The establishment of a critical mass of thoracic surgeons in each centre would lead to improved quality and delivery of care and allow for adequate coverage for on-call and continuing medical education.