The Society of Thoracic Surgeons General Thoracic Surgery Database 2017 Update on Outcomes and Quality

摘要

The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD) is a voluntary effort that provides participants with risk-adjusted semiannual performance reports that allow comparison of institutional outcomes against national benchmarks. With nearly 1,000 surgeons contributing data from more than 300 centers across North America, the STS GTSD now includes almost a half million cases. In 2016, updated risk models for lung resection and esophagectomy for cancer were reported, and composite quality measures for lobectomy and esophagectomy were developed. Ongoing efforts include upgrading the STS GTSD, establishing public reporting of lobectomy for lung cancer composite scores, creating an on-line dashboard, and strengthening international collaboration with the European Society of Thoracic Surgery Registry. With these initiatives, the STS GTSD aims to continue to improve quality of care and support research endeavors in general thoracic surgery. 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 during the past 12 months.;The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD) is the largest clinical thoracic surgical database in the world [1][1]. Established in 2002, the STS GTSD is a voluntary effort that provides participants with risk-adjusted semiannual performance reports that allow comparison of institutional outcomes against national benchmarks. The overarching mission of the STS GTSD is to support quality improvement, outcomes analysis, and research in general thoracic surgery.The STS GTSD Task Force completed multiple projects in 2016 and has undertaken new initiatives to improve the quality of thoracic surgical care, upgrade the database, and expand international collaboration. Updated risk models for lung resection and esophagectomy for cancer were reported, and composite quality measures for lobectomy and esophagectomy were developed. The STS GTSD Task Force is also in the process of upgrading the database and improving synchronization with the European Society of Thoracic Surgery (ESTS) Registry. In addition, similar to the STS Adult Cardiac Surgery Database (ACSD) and Congenital Heart Surgery Databases (CHSD), the STS GTSD has initiated public reporting of composite scores and will begin using an on-line reporting dashboard this year. This review summarizes all of the national aggregate outcome, quality measurement, and improvement initiatives from the STS GTSD during the past 12 months.Jump to SectionDatabase ParticipationRevised Lung and Esophageal Cancer Resection Risk ModelsLobectomy and Esophagectomy Composite Performance MeasuresSTS GTSD Public ReportingThe STS GTSD UpgradeAdvances in Quality and Outcomes MeetingUnderstanding the Surgeon Learning Curve for Minimally Invasive LobectomyCollaboration With the ESTSInitiatives for 2017ConclusionsReferences;Similar to the STS ACSD and STS CHSD, participation in the STS GTSD has increased each year since its inception, with 306 participants submitting data for the Fall 2016 Data Analysis Report (July 2013 through June 2016). As of February 6, 2015, the STS GTSD included data from 919 physicians (892 thoracic surgeons, 1 pulmonologist, and 26 general surgeons) at 279 United States institutions in 43 states, for a total of 482,432 operations. In addition, the STS GTSD currently has nine participation agreements pending. Two international sites, the United Arab Emirates and Singapore, also currently contribute data to the STS GTSD.;In 2016, the STS GTSD Task Force published revised lung and esophageal cancer resection risk models [2, 3]. These models are necessary to allow accurate risk adjustment when comparing institutional outcomes across the country. The first lung resection model was created in 2008 and updated in 2010, the same year that the initial esophagectomy