International collaboration sets stage for better lung cancer surgery outcomes

A unique collaboration between the Society of Thoracic Surgeons (STS) and the European Society of Thoracic Surgery (ESTS) will help improve the quality of patient care by linking outcomes data on chest procedures, beginning with lung cancer surgery, according to an article in the January 2015 issue of The Annals of Thoracic Surgery (2015; 99:368-376) .

“Our hope is that this collaboration will help identify best practices in lung cancer care in the [United States] and Europe for better patient care worldwide,” said Felix G. Fernandez, MD, from Emory University in Atlanta, Georgia, who is spearheading the effort with Alessandro Brunelli, MD, from St James's University Hospital in Leeds, England. “This collaboration has the potential to serve as an exemplar for global standardization of data collection.”

The project will utilize data from the STS General Thoracic Surgery Database (GTSD) and the ESTS Database. The GTSD is one of three components of the STS National Database, renowned especially for an Adult Cardiac Surgery Database (ACSD) which has become the gold standard for outcomes databases in the United States. The ESTS Database was created as a joint activity with the European Association for Cardio-Thoracic Surgery.

Outcomes from both databases are risk-adjusted, which means that they take into account conditions that affect results, such as a patient's age and existing health problems. Risk-adjusted outcomes are important to measure a facility's or surgeon's performance, as well as to identify which patients will be best treated by a particular procedure.

The first task for STS and ESTS was to standardize the definitions and terminology used within their respective databases. “That task represents a huge undertaking because it requires setting up a common language regarding collection of clinical information,” explained Brunelli.

“By establishing a common language, we are combining our experiences to better understand each other's processes and outcomes, which will foster clinical research collaboration across the continents and disseminate important findings faster,” added Fernandez.

STS and ESTS representatives have been holding informal discussions for several years, and during a recent collaborative process, common definitions were agreed upon by the two societies. Currently, members of the collaborative group are examining patterns of care and outcomes for lung cancer surgery from the two databases. Data and a draft manuscript have been circulated, and these outcomes will be the central topic of discussion at a gathering during the STS 51st annual meeting in San Diego.

“This project is particularly important in a specialty like thoracic surgery because we are a small community compared to other larger specialties. Increasing the pool of patient data on which to perform in-depth analyses is the only way we will be able to reliably assess our practices and produce robust guidelines to improve patient care and outcomes,” said Brunelli.

In addition to the collaboration with ESTS, STS is preparing for another milestone with the GTSD—public reporting. In early 2016, GTSD participants will have the opportunity to publicly report, on a voluntary basis, outcomes on lobectomy. ACSD outcomes have been publicly reported since 2010 and have evolved to include coronary artery bypass grafting surgery (CABG), aortic valve replacement (AVR), and AVR with CABG. In addition, 25 congenital heart surgery database participants have signed up to publicly report their risk-adjusted operative mortality results in January 2015.

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