Original article
General thoracic
Variation in Pulmonary Resection Practices Between The Society of Thoracic Surgeons and the European Society of Thoracic Surgeons General Thoracic Surgery Databases

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.2015.12.073Get rights and content

Background

Clinical guidelines are created to reduce variation in care practices, with the goal of improving patient outcomes. There is currently no international consensus on best practices for pulmonary resection. Our aim was to evaluate variation in treatment patterns and outcomes for pulmonary resection by comparing The Society of Thoracic Surgeons (STS) and the European Society of Thoracic Surgery (ESTS) general thoracic surgery databases (GTSDs).

Methods

An international collaboration was established between the STS and ESTS GTSD task forces. Patients who underwent pulmonary resection between 2010 and 2013 were identified from the 2 databases. Data on patient demographics, disease characteristics, treatment strategies, morbidity, and mortality were compared.

Results

There were 78,212 lung resections captured in the STS (n = 47,539) and ESTS databases (n = 30,673). Patients from the STS database were more likely to be of the female sex, have no pathologic N2 disease, have had previous cardiothoracic operations, and have received preoperative thoracic irradiation compared with patients from the ESTS database. In addition, patients from the STS database were more likely to have undergone a thoracoscopic operation and have received a sublobar resection. Although there was an increased risk of reintubation, atrial arrhythmias, and return to the operating room in the STS patients, the mean hospital length of stay was shorter than in patients from the ESTS database, regardless of operation performed. Thirty-day mortality was higher in the STS patients for wedge resection (p < 0.001) but lower for lobectomy (p < 0.001) and pneumonectomy (p < 0.001) compared with the ESTS patients.

Conclusions

Differences exists in patient population, procedures performed, and outcomes for pulmonary resections between the STS and ESTS databases, suggesting an opportunity for quality improvement initiatives.

Section snippets

STS and ESTS Databases

Participating institutions voluntarily contribute unselected data to the STS-GTSD. The STS-GTSD is a highly accurate, complete, and externally audited database that has been shown to have an overall accuracy of nearly 95% [8]. Detailed examination of unreported data has demonstrated no purposeful omission or gaming of data. Twice-yearly reports are returned to the institutions comparing their outcomes with other database participants to be used for quality improvement purposes. Details of the

Results

During the study period, 78,212 patients underwent pulmonary resection and were captured in the STS (n = 47,539) or ESTS databases (n = 30,673). More patients in the STS database underwent video-assisted thoracoscopic surgery (VATS) compared with those in the ESTS database (62.5% versus 21.8%; p < 0.001) (Table 1). Additionally, more patients in the STS database underwent sublobar resection compared with those in the ESTS database (43.3% versus 31.1%; p < 0.001). This included 39.4% wedge

Comment

A thoracic surgeon’s clinical decision making is multifactorial. It is influenced by patient characteristics and disease processes, as well as cultural, political, financial, and personal biases. This leads to variations in clinical practice, which may translate into variations in patient outcomes. Such variation is reflected in the current comparison of pulmonary resection practices between the STS and ESTS databases.

The 2:1 ratio of male patients to female patients who underwent pulmonary

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