The Society of Thoracic Surgeons Lung Cancer Resection Risk Model: Higher Quality Data and Superior Outcomes

Abstract

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.

The long-term impact of postoperative pulmonary complications after video-assisted thoracic surgery lobectomy for lung cancer

“…Male and elderly patients are more likely to developing MPCs after lung resection. Fernandez et al [2016] indicated that being male and elderly patients have consistently been identified as negative predictors of major postoperative complications after lung cancer surgery (23). Perioperative mortality in male patients was also significantly increased.…”

Moving beyond disease-focused decision making: understanding competing risks to personalize lung cancer treatment for older adults

“…The field of cardiothoracic surgery is fortunate to have Generation of risk models for lung cancer resection from the GTSD (6,20,21) enable thoracic surgeons to quantify the risk of operative mortality and major morbidity based on patient characteristics. While surgeons can use this information for clinical decision making and preoperative patient counseling, STS risk models are limited to 30-day outcomes.…”

“…While consensus on the precise definition of "high risk" patients for pulmonary resection remains elusive (10), risk models for 30-day mortality and postoperative morbidity demonstrate the importance of patient-dependent variables as harbingers of poor outcomes (6,11,12). However, traditional risk calculators do not facilitate comparison of cancer and noncancer specific mortality.…”

“…For pulmonary resection, the postoperative mortality rate has declined to 1.4% (6) and overall survival has improved for older patients with stage I non-small cell lung cancer (NSCLC) treated surgically (7). Safer surgery stems from a myriad of sources including advances in minimally invasive techniques as well as multidisciplinary management and sub-specialty care offered at high-volume centers.…”

Surgical risk models: how they contribute to improvement of our treatments?

“…The first of them is the Thoracoscore, derived from the national French database, Epithor (1). The second to be mention is the database of the Society of Thoracic Surgeons (2). The most recent attempt to create improved risk model was presented during the conference of the European Society of Thoracic Surgeons (ESTS) in Naples in 2016, and published thereafter in the European Journal of Cardiothoracic Surgery (3).…”