{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:48:43Z","timestamp":1753876123918,"version":"3.41.2"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2023,5,10]],"date-time":"2023-05-10T00:00:00Z","timestamp":1683676800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,10,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Esophagectomy is a complex operation with significant morbidity and mortality. Previous studies have shown that sub-specialization is associated with improved esophagectomy outcomes. We hypothesized that disparities would exist among esophagectomy patients regarding access to thoracic surgeons based on demographic, geographic, and hospital factors. The Premier Healthcare Database was used to identify adult inpatients receiving esophagectomy for esophageal and gastric cardia cancer, Barrett\u2019s esophagus, and achalasia from 2015 to 2019 using ICD-10 codes. Patients were categorized as receiving their esophagectomy from a thoracic versus non-thoracic provider. Survey methodology was used to correct for sampling error. Backwards selection from bivariable analysis was used in a survey-weighted multivariable logistic regression to determine predictors of esophagectomy provider specialization. During the study period, 960 patients met inclusion criteria representing an estimated population size of 3894 patients. Among them, 1696 (43.5%) were performed by a thoracic surgeon and 2199 (56.5%) were performed by non-thoracic providers. On multivariable analysis, factors associated with decreased likelihood of receiving care from a thoracic provider included Black (OR 0.41, p\u2009&amp;lt;\u20090.001), Other (OR 0.21, p\u2009&amp;lt;\u20090.001), and Unknown race (OR 0.22, p\u2009=\u20090.04), and uninsured patients (OR 0.53, p\u2009=\u20090.03). Urban hospital setting was associated with an increased likelihood of care by a thoracic provider (OR 4.43, p\u2009=\u20090.001). In this nationally representative study, Nonwhite race, rural hospital setting, and lower socioeconomic status were factors associated with decreased likelihood of esophagectomy patients receiving care from a thoracic surgeon. Efforts to address these disparities and provide appropriate access to thoracic surgeons is warranted.<\/jats:p>","DOI":"10.1093\/dote\/doad025","type":"journal-article","created":{"date-parts":[[2023,5,11]],"date-time":"2023-05-11T07:27:23Z","timestamp":1683790043000},"source":"Crossref","is-referenced-by-count":3,"title":["Disparities and access to thoracic surgeons among esophagectomy patients in the United States"],"prefix":"10.1093","volume":"36","author":[{"given":"Christine E","family":"Alvarado","sequence":"first","affiliation":[{"name":"University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine Division of Thoracic and Esophageal Surgery, Department of Surgery, , Cleveland, OH , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie G","family":"Worrell","sequence":"additional","affiliation":[{"name":"University of Arizona Section of Thoracic Surgery, Department of Surgery, , Tucson, AZ , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anuja L","family":"Sarode","sequence":"additional","affiliation":[{"name":"University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine UH-RISES: Research in Surgical Outcomes and Effectiveness, Department of Surgery, , Cleveland, OH , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aria","family":"Bassiri","sequence":"additional","affiliation":[{"name":"University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine Division of Thoracic and Esophageal Surgery, Department of Surgery, , Cleveland, OH , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boxiang","family":"Jiang","sequence":"additional","affiliation":[{"name":"University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine Division of Thoracic and Esophageal Surgery, Department of Surgery, , Cleveland, OH , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip A","family":"Linden","sequence":"additional","affiliation":[{"name":"University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine Division of Thoracic and Esophageal Surgery, Department of Surgery, , Cleveland, OH , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher W","family":"Towe","sequence":"additional","affiliation":[{"name":"University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine Division of Thoracic and Esophageal Surgery, Department of Surgery, , Cleveland, OH , USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,5,10]]},"reference":[{"issue":"8","key":"2023102807345181400_ref1","doi-asserted-by":"crossref","first-page":"1523","DOI":"10.1007\/s11605-014-2514-4","article-title":"The subspecialization of surgery: a paradigm shift","volume":"18","author":"Bruns","year":"2014","journal-title":"J Gastrointest Surg"},{"issue":"2","key":"2023102807345181400_ref2","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1002\/bjs.5714","article-title":"A systematic review of the impact of volume of surgery and specialization on patient outcome","volume":"94","author":"Chowdhury","year":"2007","journal-title":"Br J Surg"},{"issue":"4","key":"2023102807345181400_ref3","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1016\/j.athoracsur.2008.12.030","article-title":"Surgeon specialty and long-term survival after pulmonary resection for lung cancer","volume":"87","author":"Farjah","year":"2009","journal-title":"Ann Thorac Surg"},{"issue":"6","key":"2023102807345181400_ref4","doi-asserted-by":"crossref","first-page":"1958","DOI":"10.1016\/j.athoracsur.2011.05.120","article-title":"Intraoperative oncologic staging and outcomes for lung cancer resection vary by surgeon specialty","volume":"92","author":"Ellis","year":"2011","journal-title":"Ann Thorac Surg"},{"issue":"1","key":"2023102807345181400_ref5","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/j.1365-2753.2010.01525.x","article-title":"Surgical specialization and training - 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