General Thoracic Surgery

Abstract

General thoracic surgery is a dynamic specialty, and new techniques and therapies continue to evolve. Basic research is expanding through efforts of the Thoracic Surgery Foundation for Research and Education, and clinical research continues despite managed care. These are interesting times for this very viable specialty. There has been recent concern expressed as to what name we should define ourselves by as a subspecialty of thoracic surgery. The Liaison Committee for Thoracic Surgery was established by the Council of the American Association for Thoracic Surgery, and this committee’s actions and recommendations have resulted in a much clearer definition of the general thoracic surgeon. The term “general thoracic surgery” appears to be a viable and thriving definition of what we are about. Orringer clearly addressed the issue of what we should call ourselves and asked for clarification on who does what to whom.1 The term “general thoracic surgery” appears to be one that will be maintained. The General Thoracic Surgical Club recently celebrated its 10-year anniversary at its annual meeting and continues to thrive. Its membership is represented on many thoracic surgical policy-making committees, and this organization clearly champions the role of general thoracic surgery in our specialty. The Thoracic Surgery Directors Association has published a thoracic surgical curriculum that encompasses adult cardiac, pediatric cardiac, and general thoracic surgery.2 The general thoracic surgical aspect of the curriculum will only potentiate the momentum that general thoracic surgery has achieved in the past 10 years. The curriculum implementation task force of the Thoracic Surgery Directors Association is moving forward with this curriculum for all training programs. Monitoring of quality care and cost-cutting measures are continually being discussed and implemented. Cardiac surgical costcutting measures have received emphasis in most major medical centers because of volume and length of stay in intensive care units. Publications on cost containment in general thoracic surgery have been minimal. Wright and colleagues described a patient-care pathway that reduced length of stay and hospital costs.3 An important aspect of this study was that unit costs (not hospital charges) were available for items and services used in patient care. The mean length of stay for lobectomy patients was reduced by 3.1 days after the pathway was instituted, and the mean cost reduction was $1,271 per patient. Morbidity and mortality data were similar to those in a group of retrospectively analyzed prepathway lobectomy patients, indicating that quality of care was not hampered by this pathway. General thoracic surgeons must familiarize themselves with these types of cost-cutting measures.