Background
The Society of Thoracic Surgeons (STS) creates risk adjustment models for common cardiothoracic operations for quality improvement purposes. Our aim was to update the lung cancer resection risk model utilizing the STS General Thoracic Surgery Database (GTSD) with a larger and more contemporary cohort.
Methods
We queried the STS GTSD for all surgical resections of lung cancers from January 1, 2012 through December 31, 2014 Logistic regression was used to create three risk models for adverse events: operative mortality, major morbidity and composite mortality and major morbidity.
Results
27,844 lung cancer resections were performed at 231 centers. 62% (n=17,153) were performed via thoracoscopy. The mortality rate was 1.4% (n=401), major morbidity rate was 9.1% (n=2,545) and the composite rate was 9.5% (2,654). Predictors of mortality included age, male gender, FEV1, body mass index, cerebrovascular disease, steroids, coronary disease, peripheral vascular disease, renal dysfunction, Zubrod score, American Society of Anesthesiologists rating, thoracotomy approach, induction therapy, reoperation, tumor stage, and greater extent of resection. (all p<0.05). For major morbidity and the composite measure, cigarette smoking becomes a risk factor while stage, renal dysfunction, congestive heart failure, and cerebrovascular disease lose significance.
Conclusions
Operative mortality and complication rates are low for lung cancer resection among surgeons participating in the GTSD. Risk factors from the prior lung cancer resection model are refined and new risk factors such as prior thoracic surgery are identified. The GTSD risk models continue to evolve as more centers report and data is audited for quality assurance.
