ABSTRACT
BACKGROUND: Diversity in the physician workforce improves patient care, physician well-being, and innovation. Workforce diversity is dependent on fair compensation that is unbiased by race or ethnicity. The purpose of this study was to determine whether a disparity of representation and salary on the basis of race or ethnicity exists in academic cardiothoracic surgery. METHODS: Study investigators performed a cross-sectional analysis of data collected by the Accreditation Council of Graduate Medical Education (ACGME) and the Association of American Medical Colleges (AAMC) faculty data for US medical school faculty 2021 and 2022. Salary data were not available if an academic rank and race or ethnicity had fewer than 6 cardiothoracic surgeons. Study investigators performed a descriptive analysis of the number of faculty and compared median and mean salaries according to academic rank using a paired t test. RESULTS: Of the 758 academic cardiothoracic surgeons, 64.9% were White, 25.2% were Asian, 3.3% were Black or African American, 4.9% were Hispanic or Latino, and 1.7% were of other race or ethnicity. Cardiothoracic surgeons at the academic rank of professor were 74.6% White, 17.7% Asian, 3.4% Black or African American, 3.9% Hispanic or Latino, and 0.4% other races. Asian faculty earned 89% to 171%, Black or African American faculty earned 59% to 94%, and Hispanic or Latino faculty earned 84% to 165% of the median salary earned by White faculty. Black or African American faculty consistently and significantly (P = .002) earned lower median salaries compared with White faculty at each academic rank measured. CONCLUSIONS: The academic cardiothoracic surgery workforce lacks diversity, especially at the highest academic ranks. Salary equity among races or ethnicities is complex, requiring additional study. However, Black or African American cardiothoracic surgeons experience low representation and salary disparity at every academic rank measured.
ABSTRACT
Background: Bronchoscopic lung volume reduction (BLVR) has supplanted surgery in the treatment of patients with advanced emphysema, but not all patients qualify for it. Our study aimed to investigate the outcomes of lung volume reduction surgery (LVRS) among patients who either failed BLVR or were not candidates for it. Methods: We conducted a retrospective analysis of patients who underwent LVRS for upper lobe-predominant emphysema at a single tertiary center between March 2018 and December 2022. The main outcomes measures were preoperative and postoperative respiratory parameters, perioperative morbidity, and mortality. Results: A total of 67 LVRS recipients were evaluated, including 10 who had failed prior valve placement. The median patient age was 69 years, and 35 (52%) were male. All procedures were performed thoracoscopically, with 36 patients (53.7%) undergoing bilateral LVRS. The median hospital length of stay was 7 days (interquartile range, 6-11 days). Prolonged air leak (>7 days) occurred in 20 patients. There was one 90-day mortality from a nosocomial pneumonia (non-COVID-related) and no further deaths at 12 months. There were mean improvements of 10.07% in forced expiratory volume in 1 second and 4.74% in diffusing capacity of the lung for carbon monoxide, along with a mean decrease 49.2% in residual volume (P < .001 for all). The modified Medical Research Council dyspnea scale was improved by 1.84 points (P < .001). Conclusions: LVRS can be performed safely in patients who are not candidates for BLVR and those who fail BLVR and leads to significant functional improvement. Long-term follow-up is necessary to ensure the sustainability of LVRS benefits in this patient population.
ABSTRACT
Patient-reported outcome (PRO) scores have been utilized more frequently, but the relationship of PRO scores to determinants of health and social inequities has not been widely studied. Our goal was to determine the association of PRO scores with social determinants. All patients with a new cancer diagnosis who completed a PRO survey from 2020 to 2022 were included. The PRO survey recorded scores for depression, fatigue, pain interference and physical function. Higher depression, fatigue and pain scores indicated more distress. Higher physical condition scores indicated improved functionality. A total of 1090 patients were included. Married patients had significantly better individual PRO scores for each domain. Patients who were able to use the online portal to complete their survey also had better individual scores. Male patients and non-White patients had worse pain scores than female and White patients, respectively. Patients with prostate cancer had the best scores while patients with head and neck and lung cancer had the worst scores. PRO scores varied by cancer disease site and stage. Social support may act in combination with specific patient/tumor factors to influence PRO scores. These findings present opportunities to address patient support at institutional levels.