Variation in use of video assisted thoracic surgery in the United Kingdom
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《英国医生杂志》
1 Health Services Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, 2 Cardiothoracic Unit, Guy's Hospital, London SE1 9RT
Correspondence to: T Treasure tom.treasure@gstt.sthames.nhs.uk
Introduction
There is wide variation in the adoption of VATS in UK thoracic surgery. We believe this variation is more likely to be related to preferences of individual surgeons rather than the facilities available because the correlation between use of VATS for pneumothorax and minor resections is not strong. Although some variation may be related to differences in patients' characteristics, differences in case mix are unlikely to explain this large variation in practice. Given the evidence for VATS use in pneumothorax and minor lung resections5 the large variation in the implementation of this technology deserves reflection. The transition from a policy of full thoracotomy to the new technology takes retraining and practice, but those who have adopted VATS find that rather than being a compromise procedure, undertaken to spare the patient a thoracotomy and to reduce pain and bed days, it is a technically better approach. The surgeon operates in a comfortable position with an enhanced and well lit view of the operative field, which is seen equally well by everyone in the operating room. This greatly facilitates training and supervision.
Data were voluntarily provided by members of the Society of Cardiothoracic Surgeons of Great Britain and Ireland. Tom Treasure is responsible to the society for the collection and collation of these data and has a mandate from the society's annual general meeting of its members to disseminate information based on the data.
Contributors: AS, TT, and JvdM were responsible for study concept and design. TT and AS were responsible for acquisition of the data and administrative, technical, or material support. AS and JL analysed the data and provided statistical expertise. AS drafted and TT finalised the manuscript. All authors interpreted the results and critically revised the manuscript for important intellectual content. TT and AS are guarantors.
Funding: There was no specific funding for this study.
Competing interests: None declared.
Ethical approval: Not required.
References
Lewis RJ, Caccavale RJ, Sisler GE, Mackenzie JW. One hundred consecutive patients undergoing video-assisted thoracic operations. Ann Thorac Surg 1992;54: 421-6.
Wennberg JE. Understanding geographic variations in health care delivery. N Engl J Med 1999;340: 52-3.
Detsky AS. Regional variation in medical care. N Engl J Med 1995;333: 589-90.
Laycock WS, Siewers AE, Birkmeyer CM, Wennberg DE, Birkmeyer JD. Variation in the use of laparoscopic cholecystectomy for elderly patients with acute cholecystitis. Arch Surg 2000;135: 457-62.
Sedrakyan A, van der Meulen J, Lewsey J, Treasure T. Video assisted thoracic surgery for treatment of pneumothorax and lung resections: systematic review of randomised clinical trials. BMJ 2004;329:.(Artyom Sedrakyan, honorar)
Correspondence to: T Treasure tom.treasure@gstt.sthames.nhs.uk
Introduction
There is wide variation in the adoption of VATS in UK thoracic surgery. We believe this variation is more likely to be related to preferences of individual surgeons rather than the facilities available because the correlation between use of VATS for pneumothorax and minor resections is not strong. Although some variation may be related to differences in patients' characteristics, differences in case mix are unlikely to explain this large variation in practice. Given the evidence for VATS use in pneumothorax and minor lung resections5 the large variation in the implementation of this technology deserves reflection. The transition from a policy of full thoracotomy to the new technology takes retraining and practice, but those who have adopted VATS find that rather than being a compromise procedure, undertaken to spare the patient a thoracotomy and to reduce pain and bed days, it is a technically better approach. The surgeon operates in a comfortable position with an enhanced and well lit view of the operative field, which is seen equally well by everyone in the operating room. This greatly facilitates training and supervision.
Data were voluntarily provided by members of the Society of Cardiothoracic Surgeons of Great Britain and Ireland. Tom Treasure is responsible to the society for the collection and collation of these data and has a mandate from the society's annual general meeting of its members to disseminate information based on the data.
Contributors: AS, TT, and JvdM were responsible for study concept and design. TT and AS were responsible for acquisition of the data and administrative, technical, or material support. AS and JL analysed the data and provided statistical expertise. AS drafted and TT finalised the manuscript. All authors interpreted the results and critically revised the manuscript for important intellectual content. TT and AS are guarantors.
Funding: There was no specific funding for this study.
Competing interests: None declared.
Ethical approval: Not required.
References
Lewis RJ, Caccavale RJ, Sisler GE, Mackenzie JW. One hundred consecutive patients undergoing video-assisted thoracic operations. Ann Thorac Surg 1992;54: 421-6.
Wennberg JE. Understanding geographic variations in health care delivery. N Engl J Med 1999;340: 52-3.
Detsky AS. Regional variation in medical care. N Engl J Med 1995;333: 589-90.
Laycock WS, Siewers AE, Birkmeyer CM, Wennberg DE, Birkmeyer JD. Variation in the use of laparoscopic cholecystectomy for elderly patients with acute cholecystitis. Arch Surg 2000;135: 457-62.
Sedrakyan A, van der Meulen J, Lewsey J, Treasure T. Video assisted thoracic surgery for treatment of pneumothorax and lung resections: systematic review of randomised clinical trials. BMJ 2004;329:.(Artyom Sedrakyan, honorar)