A clinical audit in a multidisciplinary care path for thoracic surgery: An instrument for continuous quality improvement (original) (raw)
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Informed consent prior to any surgical intervention should include in-hospital survival estimation after the procedure performed. The recently developed Thoracoscore predicts well the postoperative mortality possibility. The purpose of our study was to test the modified Thoracoscore performance in our new thoracic program. One hundred and fifty-five consecutive patients underwent thoracic surgery procedure within two years. The procedures performed were: 62 lung resections, 10 open tumor biopsies, 21 neck and mediastinal procedures, 33 chest wall and pleural procedures, 8 tracheal procedures, 3 esophageal procedures, 13 minor cardiac procedures, and 5 chest trauma cases. The modified Thoracoscore was calculated based on the following variables: age, gender, priority of the procedure, malignancy, type of procedure, Zubrod score, ASA class, and number of co-morbidities. The observed mortality was 5.2% (eight deaths) while the predicted one based on the modified Thoracoscore was 4.9%. ...
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Accurate measurement of outcomes is essential to monitor the effectiveness of public health policies. In Italy, the Ministry of Health has chosen 30-day mortality after major surgical or medical procedures as the main outcome measure, pooling all pulmonary resections for malignancy in a single category. The present audit evaluated all pulmonary resections performed over a 13-year period in a single institution to assess the immediate (30-day mortality) and long-term (5-year survival) outcomes according to type and stage of disease and extent of surgery. We analyzed the results of 4,234 first pulmonary resections performed from 2003 to 2015 for lung cancer (2,636), lung metastases (1,080), other primary cancers (259) and benign diseases (259). The median follow-up of cancer patients was 4.1 years. Overall 30-day mortality was 1.1%, being 1.2% for lung cancer, 0.3% for lung metastases, 3.5% for pneumonectomies, 1% for lobectomies, and 0.5% for sublobar resections. Among lung cancer pa...
How to evaluate quality for Thoracic Lung Cancer Surgery: A ‘’textbook outcome’’
Medical Research Archives, 2015
Objectives-Measuring surgical quality gives rise to an ongoing debate on which quality of care indicators should be used. Individual measures such as postoperative mortality, do not fully reflect quality of care. Instead, a summarizing measure (i.e. a "textbook outcome") can be used. The objectives of this study were to investigate the proportion of patients with a ""textbook outcome"" and to identify variables reducing the chance for a ""textbook outcome"". Materials and Methods-From January 2003 to December 2011, 152 patients operated for non-small cell lung carcinoma (NSCLC) were identified using both a prospective database (N=93) which was incorporated in a multidisciplinary care path for thoracic surgery in the Netherlands Cancer Institute, and a retrospective database (N=59). Patient-, tumour-, treatment-and outcome characteristics were collected. A ""textbook outcome"" was defined as a postoperative course without in-hospital death, without complications within 30 days, without re-intervention within 30 days, and without re-admission within 30 days after discharge, in combination with a radical tumour resection, a hospital stay < 16 days and an Intensive Care stay < 3 days. Results-In 96 of 152 patients (63%), a ""textbook outcome"" was realized. A logistic regression analysis including stage of disease, pulmonary co-morbidity, smoking Medical Research Archives
The Annals of thoracic surgery, 2017
A critical gap in The Society of Thoracic Surgeons (STS) Database is the absence of patient-reported outcomes (PRO), which are of increasing importance in outcomes and performance measurement. Our aim was to demonstrate the feasibility of integrating PRO into the STS Database for patients undergoing lung cancer operations. The National Institutes of Health Patient Reported Outcome Measurement Information System (PROMIS) includes reliable, precise measures of PRO. We used validated item banks within PROMIS to develop a survey for patients undergoing lung cancer resection. PRO data were prospectively collected electronically on tablet devices and merged with our institutional STS data. Patients were enrolled over 18 months (November 2014 to May 2016). The survey was administered preoperatively and at 1 and 6 months after lung cancer resection. The study included 127 patients. All patients completed the initial postoperative survey, and 108 reached the 6-month follow-up. The most commo...
Systematic Classification of Morbidity and Mortality After Thoracic Surgery
The Annals of Thoracic Surgery, 2010
Background. Objective reporting of postoperative complications is the foundation of surgical quality assurance. We developed a system to identify both presence and severity of thoracic morbidity and mortality, and evaluated its feasibility and utility over the first two years of its implementation. Methods. The system was based on the Clavien-Dindo classification, in which the severity of a complication is proportional to the effort to treat it. Definitions were developed by peer review and questionnaire. All patients undergoing thoracic surgery (January 2008 to December 2009) were prospectively evaluated.
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Background: An unplanned return to the operating room (UROR) is defined as a readmission to the operating room because of a complication or an untoward outcome related to the initial surgery. The aim of the present report is to evaluate the role of URORs after elective oncologic thoracic surgery. Methods: In the study, 4012 consecutive patients were enrolled; among them, 71 patients (1.76%) had an unplanned return to the operating room. Age, sex, Charlson comorbidity index, induction treatments, type of the first operation, indication to readmission to the operating room and type of second operation, length of stay, complication after reoperation and outcomes were collected. Results: The mean age was 63.3 (SD: 13.0); there were 53 male patients (74.6%); the type of the first procedure was: lower lobectomy (11.3%), middle lobectomy (1.4%), upper lobectomy (22.5%), metastasectomy (5.6%), extrapleural pneumonectomy (4.2%), pneumonectomy (40.9%), pleural biopsy (5.6%) and other procedur...
The Place of Patient Satisfaction in Quality Assessment of Lung Cancer Thoracic Surgery
Chest, 2005
Study objectives: To compare the quality of non-small cell lung cancer (NSCLC) surgical care with patient satisfaction. Design: Prospective study. Setting: Academic hospital departments of thoracic oncology and surgery. Patients and methods: Patients presenting with recently diagnosed NSCLC and eligible for front-line thoracic surgery were eligible. Patient satisfaction was assessed using the Questionnaire of Satisfaction of Hospitalized Patients. Quality of surgical care was evaluated using an original score built accordingly to British Thoracic Society guidelines. Univariate analysis used parametric (Pearson correlation, t test) and nonparametric tests (Mann-Whitney U test) according to test conditions. Probability of survival was estimated using the Kaplan-Meier method. Results: Seventy patients (mean age, 63.7 years) were included. Lobectomy was performed in 62 cases, and pneumonectomy was performed in 8 cases. In all, 28 patients had a postoperative complication. One-year survival rates for patients with stage I-II and stage IIIA NSCLC were 84% and 58%, respectively. Mean patient satisfaction was 78 ؎ 13/100 and 69 ؎ 13/100 for global staff and structure index, respectively (؎ SD). Mean score for quality of surgical care was 88.7/100 (range, 51 to 100). The absence of postoperative complication was significantly related to a high level of satisfaction regarding the structure (r ؍ 0.30, p < 0.05). Other features of patient satisfaction did not show a significant correlation with the quality of the preoperative selection process or the surgical procedure itself (r < 0.20). Conclusions: Considering the lack of significant correlation, the present study does not support a shortcut between quality of care and patient satisfaction. Nonetheless, patient satisfaction should be integrated into rather than substituted for the quality of health-care assessment, which also needs further development.
The Annals of Thoracic Surgery, 2011
Background. Minimizing adverse events after surgery is widely recognized as an important indicator of quality; yet no consensus has been reached on how to standardize the reporting of adverse events after surgical procedures. Our objectives were to develop a standardized classification system to monitor both the presence and severity of thoracic morbidity and mortality, and to evaluate its reliability and reproducibility among a national cohort of thoracic surgeons.