The Society of Thoracic Surgeons Composite Score for Rating Program Performance for Lobectomy for Lung Cancer

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• 作者：Benjamin D. Kozower ; MD ; MPH^a ; ^{bdk8g@virginia.edu" class="auth_mail" title="E-mail the corresponding author} ; Sean M. O&rsquo ; Brien ; PhD^b ; Andrzej S. Kosinski ; PhD^b ; Mitchell J. Magee ; MD^c ; Rachel Dokholyan ; MPH^b ; Jeffery P. Jacobs ; MD^d ; David M. Shahian ; MD^e ; Cameron D. Wright ; MD^e ; Felix G. Fernandez ; MD^f
• 刊名：The Annals of Thoracic Surgery
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：101
• 期：4
• 页码：1379-1387
• 全文大小：414 K

文摘

The Society of Thoracic Surgeons (STS) has developed multidimensional composite quality measures for common cardiac surgery procedures. This first composite measure for general thoracic surgery evaluates STS participant performance for lobectomy in lung cancer patients.

Methods

The STS lobectomy composite score is composed of two outcomes: risk-adjusted mortality; and any-or-none, risk-adjusted major complications. General Thoracic Surgery Database data were included from 2011 to 2014 to provide adequate sample size, and 95% Bayesian credible intervals were used to determine “star ratings.” The STS participants were also compared with national benchmarks (including non-STS participants) using the National Inpatient Sample. Comparisons of discharge mortality, postoperative length of stay, and percent of stage I lung cancers resected using minimally invasive approaches are not included in star ratings but will be reported to participants in STS feedback reports.

Results

The study population included 20,657 lobectomy patients from 231 participating centers. Operative mortality was 1.5%, major complication rate was 9.6%, and median postoperative length of stay was 4 days. Risk-adjusted mortality and major complication rates varied threefold from highest performing (three-star) to lowest performing (one-star) programs. Approximately 5% of participants were one-star, 7% were three-star, and 88% were two-star programs.

Conclusions

The STS has developed the first general thoracic surgery quality composite measure to compare programs performing lobectomy for lung cancer. This measure will be used for quality assessment and provider feedback, and will be made available for voluntary public reporting.