Outcomes analysis, quality improvement, and patient safety
The Society of Thoracic Surgeons General Thoracic Surgery Database Update on Outcomes and Quality

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The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD) is a voluntary effort that provides participants with semiannual, risk-adjusted performance reports that facilitate quality improvement and comparison of institutional outcomes with national benchmarks. With improved participation in the STS GTSD, increasingly meaningful analyses are available. This year, risk models for lobectomy and esophagectomy for cancer were updated. In addition, we developed the first composite quality measure for general thoracic surgery, a composite measure for lobectomy for lung cancer. Furthermore, international collaboration with the European Society of Thoracic Surgery has facilitated our understanding of variation between American and European treatment patterns, providing a foundation for future quality improvement initiatives. This article summarizes current aggregate national outcomes in general thoracic surgery and reviews related activities in the areas of quality measurement, performance improvement, and transparency from the STS GTSD over the past 12 months.

Section snippets

Database Participation and Aggregate Outcomes

Similar to the STS adult cardiac and congenital heart surgery databases, participation in the STS GTSD has increased each year since its inception in 2002, with 261 participants contributing to the data harvest in 2014 (Fig 1) [4]. As of November 9, 2015, the STS GTSD included data from 892 surgeons (868 thoracic and 24 general surgeons) at 274 US institutions in 44 states, for a total of 438,603 operations (Fig 2). In addition, nine surgeons in the United Arab Emirates have agreed to

Harmonization of Definitions With ESTS

The STS GTSD and ESTS database were independently created for the purpose of objectively measuring processes and outcomes with the goal of improving the quality of thoracic surgical care. However, direct comparison of the databases was difficult owing to significant differences in variables included and data definitions. To facilitate efficient and accurate intersocietal collaboration, members of the STS GTSD and ESTS Database Task Forces worked to standardize terminology and harmonize

Lobectomy for Lung Cancer Composite Score

Composite performance measures have been developed in cardiac surgery by the STS Quality Measurement Task Force for coronary artery bypass graft surgery, aortic valve replacement, and coronary artery bypass graft surgery plus aortic valve replacement 6, 7, 8. These measures have been made available to the public for the purpose of comparing the quality of care between programs [9]. However, until this year, no such measure has been developed in general thoracic surgery. Because lobectomy is the

Updated Lung and Esophageal Cancer Resection Risk Models

The STS has previously reported several risk-adjustment models to predict outcomes of individual patients undergoing specific cardiothoracic procedures 6, 7, 8, 11, 15, 16. In adult cardiac surgery, that has resulted in an online calculator for common cardiac procedures that predicts risk of morbidity, mortality, and hospital length of stay, among other outcomes [17]. In 2008, the STS GTSD created the first lung resection risk model [15], which was updated in 2010 [11], with the outcome

National Quality Forum-Endorsed Measures

The NQF currently administers the national library of endorsed performance measures. The NQF is contracted by the US Department of Health and Human Services to establish “a portfolio of quality and efficiency measures that will allow the federal government to more clearly see how and whether healthcare spending is achieving the best results for patients and taxpayers” [22]. By 2017, nearly 10% of all Medicare payment is expected to be performance-based with appropriate measures designated by

Initiatives for 2016

The GTSD has begun work on several additional projects for 2016. First, we are developing the second composite quality measure for esophagectomy for esophageal cancer. Next, we are working hard to incorporate long-term survival in the database. The GTSD incorporated data fields into version 2.3 to capture 5-year survival for all lung and esophageal cancer resections. In addition, Dr Felix Fernandez is leading STS on a project funded by the Agency for HealthCare Research and Quality to link STS

Conclusion

With improved participation in the STS GTSD, increasingly meaningful analyses are possible. With data from nearly a half million cases available, risk models for lung resection and esophagectomy for cancer have been revised and the first general thoracic composite quality measure has been developed. In addition, international collaboration has opened new doors to understanding variation between American and European treatment patterns, building a foundation for future quality-improvement

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