Assessing the Status of Thoracic Surgical Research and Quality Improvement Programs: A Survey of the Members of the Canadian Association of Thoracic Surgeons (original) (raw)
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Lung Cancer, 2012
Background: Although it is advocated that (major) surgical procedures should be embedded in clinical pathways, the efficacy of such pathways is hardly ever systematically evaluated. The objective of our study was to assess the results of a multidisciplinary care path for patients undergoing thoracic cancer surgery, using a concurrent integrated prospective database. Methods: From April 2006 to December 2008, 169 eligible patients, admitted for thoracic cancer surgery in our institute, gave informed consent to participate in this prospective study. Detailed clinical data concerning patient-, tumour-, treatment-and outcome characteristics were collected. For evaluation of pain and quality of life (QoL), visual analogue scale (VAS) and SF-36 were used respectively. Information retrieved on 94 patients operated in the baseline period (until November 2007) was used in multidisciplinary consensus meetings to develop a new care path. After the introduction of this care path (January 2008) data-collection continued to evaluate outcome using the data of 75 patients operated in the evaluation period (until December 2008). Results: Data from the baseline period showed age (p = 0.001), indication (p = 0.03), postoperative pain (p < 0.001) and complications (p < 0.001) to be independently related to length of stay (LOS). Subsequently, the package of measures taken in the multidisciplinary care path were evaluated, showing significantly less postoperative pain (p = 0.026) and a reduced length of hospital stay (p = 0.014). In addition, a (trend towards) improvement in physical quality of life was observed 1 month (p = 0.03) and 6 months (p = 0.07) postoperatively. Conclusion: The use of a prospective database integrated in a clinical care path for thoracic cancer patients revealed important improvements of the care process determining short-and long-term outcome. There was a significant reduction in length of hospital stay, postoperative pain and loss of quality of life. Ongoing and multicentre collection of such data can provide surgeons with instruments to further improve quality of care.
Beyond borders—international database collaboration in thoracic surgery
Journal of Thoracic Disease
Thoracic surgery databases continue to emerge as pillars for institutional quality improvement and research endeavors. This paper reviews the current state of the largest thoracic surgery databases: the Thoracic Surgeons General Thoracic Surgery Database (STS-GTSD) and the European Society of Thoracic Surgery Database (ESTSD). In addition, we utilize these as a platform to evaluate the role and key ingredients for successful international database collaborations. Ultimately, collaborative efforts among large databases unify research efforts, foster cohesion, serve as benchmarks for quality improvement locally, nationally and internationally, promote comparative innovation, and ultimately improve patient outcomes.
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.
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.
The Society of Thoracic Surgeons National Database status report☆
The Annals of Thoracic Surgery, 1994
Chairman, Ad Hoc Committee* to Develop a National Database for Thoracic Surgery This report describes the development of the first known national surgical database designed for the practicing community cardiothoracic surgeon. Acceptance by members of The Society of Thoracic Surgeons has been gratifying. The number of patients on the system has grown from 116,109 at the end of 1991 to an anticipated 350,000 to 450,000 by the end of 1993. At the time of this report, 842 surgeons were participating, and more than 1,200 will be on the system by the end of 1993. A risk stratification system has been incorporated into the software, which predicts each patient's risk based on the individual surgeon's past experience. Trend analyses his status report is a compilation of the activities of the
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%. ...
Redundancy and variability in quality and outcome reporting for cardiac and thoracic surgery
Proceedings (Baylor University. Medical Center), 2015
Health care is evolving into a value-based reimbursement system focused on quality and outcomes. Reported outcomes from national databases are used for quality improvement projects and public reporting. This study compared reported outcomes in cardiac and thoracic surgery from two validated reporting databases-the Society of Thoracic Surgeons (STS) database and the National Surgical Quality Improvement Program (NSQIP)-from January 2011 to June 2012. Quality metrics and outcomes included mortality, wound infection, prolonged ventilation, pneumonia, renal failure, stroke, and cardiac arrest. Comparison was made by chi-square analysis. A total of 737 and 177 cardiac surgery cases and 451 and 105 thoracic surgery cases were captured by the STS database and NSQIP, respectively. Within cardiac surgery, there was a statistically significant difference in the reported rates of prolonged ventilation, renal failure, and mortality. No significant differences were found for the thoracic surgery...