Stephen R Broderick1, Maria Grau-Sepulveda2, Andrzej S Kosinski2, Paul A Kurlansky3, David M Shahian4, Jeffrey P Jacobs5, Susan Becker6, Malcolm M DeCamp7, Christopher W Seder8, Eric L Grogan9, Lisa M Brown10, William Burfeind11, Mitchell Magee12, Daniel P Raymond13, Varun Puri14, Andrew C Chang15, Benjamin D Kozower14. 1. Division of Thoracic Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland. Electronic address: sbroder7@jhmi.edu. 2. Duke Clinical Research Institute, Durham, North Carolina. 3. Department of Surgery, Columbia University, New York, New York. 4. Department of Surgery, Harvard Medical School, Boston, Massachusetts. 5. Division of Cardiac Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland. 6. The Society of Thoracic Surgeons National Database, Chicago, Illinois. 7. Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. 8. Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Illinois. 9. Department of Surgery, Vanderbilt University, Nashville, Tennessee. 10. Department of Surgery, University of California, Davis Health, Sacramento, California. 11. Department of Surgery, St Luke's University Health Network, Bethlehem, Pennsylvania. 12. Department of Surgery, Medical City Dallas Hospital, Dallas, Texas. 13. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. 14. Department of Surgery, Washington University School of Medicine, St Louis, Missouri. 15. Section of Thoracic Surgery, Michigan Medicine, Ann Arbor, Michigan.
Abstract
BACKGROUND: The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTSD) has developed composite quality measures for lobectomy and esophagectomy. This study sought to develop a composite measure including all resections for lung cancer. METHODS: The STS lung cancer composite score is based on 2 outcomes: risk-adjusted mortality and morbidity. GTSD data were included from January 2015 to December 2017. "Star ratings" were created for centers with 30 or more cases by using 95% Bayesian credible intervals. The Bayesian model was performed with and without inclusion of the minimally invasive approach to assess the impact of approach on the composite measure. RESULTS: The study population included 38,461 patients from 256 centers. Overall operative mortality was 1.3% (495 of 38,461). The major complication rate was 7.9% (3045 of 38,461). The median number of nodes examined was 10 (interquartile range, 5 to 16); the median number of nodal stations sampled was 4 (interquartile range, 3 to 5). Positive resection margins were identified in 3.7% (1420 of 38,461). A total of 214 centers with 30 or more cases were assigned star ratings. There were 7 1-star, 194 2-star, and 13 3-star programs; 70.6% of resections were performed through a minimally invasive approach. Inclusion of minimally invasive approach, which was adjusted for in previous models, altered the star ratings for 3% (6 of 214) of the programs. CONCLUSIONS: Participants in the STS GTSD perform lung cancer resection with low morbidity and mortality. Lymph node data suggest that participants are meeting contemporary staging standards. There is wide variability among participants in application of minimally invasive approaches. The study found that risk adjustment for approach altered ratings in 3% of participants.
BACKGROUND: The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTSD) has developed composite quality measures for lobectomy and esophagectomy. This study sought to develop a composite measure including all resections for lung cancer. METHODS: The STS lung cancer composite score is based on 2 outcomes: risk-adjusted mortality and morbidity. GTSD data were included from January 2015 to December 2017. "Star ratings" were created for centers with 30 or more cases by using 95% Bayesian credible intervals. The Bayesian model was performed with and without inclusion of the minimally invasive approach to assess the impact of approach on the composite measure. RESULTS: The study population included 38,461 patients from 256 centers. Overall operative mortality was 1.3% (495 of 38,461). The major complication rate was 7.9% (3045 of 38,461). The median number of nodes examined was 10 (interquartile range, 5 to 16); the median number of nodal stations sampled was 4 (interquartile range, 3 to 5). Positive resection margins were identified in 3.7% (1420 of 38,461). A total of 214 centers with 30 or more cases were assigned star ratings. There were 7 1-star, 194 2-star, and 13 3-star programs; 70.6% of resections were performed through a minimally invasive approach. Inclusion of minimally invasive approach, which was adjusted for in previous models, altered the star ratings for 3% (6 of 214) of the programs. CONCLUSIONS:Participants in the STS GTSD perform lung cancer resection with low morbidity and mortality. Lymph node data suggest that participants are meeting contemporary staging standards. There is wide variability among participants in application of minimally invasive approaches. The study found that risk adjustment for approach altered ratings in 3% of participants.
Authors: Brendan T Heiden; Daniel B Eaton; Su-Hsin Chang; Yan Yan; Martin W Schoen; Mayank R Patel; Daniel Kreisel; Ruben G Nava; Bryan F Meyers; Benjamin D Kozower; Varun Puri Journal: Ann Surg Date: 2021-05-11 Impact factor: 12.969
Authors: Karishma Kodia; Joy A Stephens-McDonnough; Ahmed Alnajar; Nestor R Villamizar; Dao M Nguyen Journal: J Thorac Dis Date: 2021-07 Impact factor: 2.895