The Society of Thoracic Surgeons Lung Cancer Resection Risk Model: Higher Quality Data and Superior Outcomes

doi:10.1016/j.athoracsur.2016.02.098

The Annals of Thoracic Surgery

Volume 102, Issue 2, August 2016, Pages 370-377

Presented at the Sixty-second Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, Nov 4–7, 2015.

https://doi.org/10.1016/j.athoracsur.2016.02.098 Get rights and content

Background

The Society of Thoracic Surgeons (STS) creates risk-adjustment models for common cardiothoracic operations for quality improvement purposes. Our aim was to update the lung cancer resection risk model utilizing the STS General Thoracic Surgery Database (GTSD) with a larger and more contemporary cohort.

Methods

We queried the STS GTSD for all surgical resections of lung cancers from January 1, 2012, through December 31, 2014. Logistic regression was used to create three risk models for adverse events: operative mortality, major morbidity, and composite mortality and major morbidity.

Results

In all, 27,844 lung cancer resections were performed at 231 centers; 62% (n = 17,153) were performed by thoracoscopy. The mortality rate was 1.4% (n = 401), major morbidity rate was 9.1% (n = 2,545), and the composite rate was 9.5% (n = 2,654). Predictors of mortality included age, being male, forced expiratory volume in 1 second, body mass index, cerebrovascular disease, steroids, coronary artery disease, peripheral vascular disease, renal dysfunction, Zubrod score, American Society of Anesthesiologists rating, thoracotomy approach, induction therapy, reoperation, tumor stage, and greater extent of resection (all p < 0.05). For major morbidity and the composite measure, cigarette smoking becomes a risk factor whereas stage, renal dysfunction, congestive heart failure, and cerebrovascular disease lose significance.

Conclusions

Operative mortality and complication rates are low for lung cancer resection among surgeons participating in the GTSD. Risk factors from the prior lung cancer resection model are refined, and new risk factors such as prior thoracic surgery are identified. The GTSD risk models continue to evolve as more centers report and data are audited for quality assurance.

Section snippets

The Society of Thoracic Surgeons Database

In 2002, The STS formally established the GTSD component of the STS National Database as a voluntary effort to support continued quality improvement efforts of thoracic surgeons and hospitals. The GTSD provides participating members with risk-adjusted national thoracic surgical benchmarks for lung and esophageal cancer resections. Risk-adjusted short-term results are provided to participating institutions on a twice-yearly basis. The STS GTSD has been externally audited since 2010 [7]. Audits

Results

A query of the STS GTSD from January 1, 2012, through December 31, 2014, revealed 27,844 patients having undergone surgery for primary lung cancer from 231 centers. Baseline patient characteristics are depicted in Table 1. The majority of patients were Caucasian (87.0%) with a past or current history of smoking (86.0%), a Zubrod performance status of 0 or 1 (95.8%; 26,678 of 27,844), and an American Society of Anesthesiologists (ASA) rating of 3 (75.3%; 20,953 of 27,844). More than half of

Comment

Surgeons submitting data to the STS GTSD perform surgical resection for lung cancer with low mortality and morbidity. Important predictors of mortality and major morbidity after lung cancer resection are identified with these models. Knowledge of such predictors informs clinical decision making by allowing physicians and patients to focus on individual patient characteristics and their impact on outcomes. These models replace prior versions of the lung cancer resection risk models [5]. The STS

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Original articleGeneral thoracicThe Society of Thoracic Surgeons Lung Cancer Resection Risk Model: Higher Quality Data and Superior Outcomes

Background

Methods

Results

Conclusions

Section snippets

The Society of Thoracic Surgeons Database

Results

Comment

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

Eur J Cancer

J Thorac Cardiovasc Surg

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

Ann Thorac Surg

Original article
General thoracic
The Society of Thoracic Surgeons Lung Cancer Resection Risk Model: Higher Quality Data and Superior Outcomes