The Society of Thoracic Surgeons Composite Score for Evaluating Esophagectomy for Esophageal Cancer

Andrew C. Chang, Andrzej S. Kosinski, Daniel P. Raymond, Mitchell J. Magee, Malcolm M. DeCamp, Farhood Farjah, Eric L. Grogan, Christopher W. Seder, Mark S. Allen, Justin D. Blasberg, Shanda H. Blackmon, William R. Burfeind, Stephen D. Cassivi, Bernard J. Park, David M. Shahian, David W. Wormuth, Jane M. Han, Cameron D. Wright, Felix G. Fernandez, Benjamin D. Kozower & 1 others The Society of Thoracic Surgeons General Thoracic Surgery Database Task Force

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background The Society of Thoracic Surgeons (STS) has developed composite quality measures for cardiac surgical procedures and lobectomy for lung cancer. This study sought to develop a composite measure for esophagectomy for esophageal cancer. Methods The STS esophagectomy composite score is derived from two risk-adjusted outcomes: mortality and major complications. General Thoracic Surgery Database data were included from 2012 to 2014, and 95% Bayesian credible intervals were established to determine “star” ratings. STS participants were compared with the National Inpatient Sample as a national benchmark (including non-STS participants). Results The study population included 4,321 patients who underwent esophagectomy from 167 participating centers. The operative mortality rate was 3.1% (N = 135), and the major complication rate was 33.1% (N = 1,429). Of the 167 participants, 70 reported an average yearly volume of five or more esophagectomies during the study period. With this threshold, reliability for the composite score was 0.58 (95% credible interval, 0.41 to 0.72). Of these 70 participants, 5 (7.1%) were three star, 63 (90.0%) were two star, and 2 (2.9%) were one star. A majority of STS participants, 58.1% (N = 97), did not have sufficient volume to receive a reliable composite score. Benchmarked to the 2012 National Inpatient Sample cohort, STS General Thoracic Surgery Database participants have comparable discharge mortality rates and shorter postoperative lengths of stay. Conclusions STS has developed a quality measure for esophageal cancer surgical procedures based on a composite score of risk-adjusted operative mortality rates and major complications. The composite rating for esophagectomy has good reliability for programs performing an average of five procedures annually, although almost 60% of participants are not eligible for a star rating because of lower procedure volumes.

Original languageEnglish (US)
Pages (from-to)1661-1667
Number of pages7
JournalAnnals of Thoracic Surgery
Volume103
Issue number5
DOIs
StatePublished - May 1 2017

Fingerprint

Esophagectomy
Esophageal Neoplasms
Thorax
Mortality
Thoracic Surgery
Inpatients
Cardiac Surgical Procedures
Databases
Benchmarking
Surgeons
Length of Stay
Lung Neoplasms
Population

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Chang, A. C., Kosinski, A. S., Raymond, D. P., Magee, M. J., DeCamp, M. M., Farjah, F., ... The Society of Thoracic Surgeons General Thoracic Surgery Database Task Force (2017). The Society of Thoracic Surgeons Composite Score for Evaluating Esophagectomy for Esophageal Cancer. Annals of Thoracic Surgery, 103(5), 1661-1667. https://doi.org/10.1016/j.athoracsur.2016.10.027

The Society of Thoracic Surgeons Composite Score for Evaluating Esophagectomy for Esophageal Cancer. / Chang, Andrew C.; Kosinski, Andrzej S.; Raymond, Daniel P.; Magee, Mitchell J.; DeCamp, Malcolm M.; Farjah, Farhood; Grogan, Eric L.; Seder, Christopher W.; Allen, Mark S.; Blasberg, Justin D.; Blackmon, Shanda H.; Burfeind, William R.; Cassivi, Stephen D.; Park, Bernard J.; Shahian, David M.; Wormuth, David W.; Han, Jane M.; Wright, Cameron D.; Fernandez, Felix G.; Kozower, Benjamin D.; The Society of Thoracic Surgeons General Thoracic Surgery Database Task Force.

In: Annals of Thoracic Surgery, Vol. 103, No. 5, 01.05.2017, p. 1661-1667.

Research output: Contribution to journalArticle

Chang, AC, Kosinski, AS, Raymond, DP, Magee, MJ, DeCamp, MM, Farjah, F, Grogan, EL, Seder, CW, Allen, MS, Blasberg, JD, Blackmon, SH, Burfeind, WR, Cassivi, SD, Park, BJ, Shahian, DM, Wormuth, DW, Han, JM, Wright, CD, Fernandez, FG, Kozower, BD & The Society of Thoracic Surgeons General Thoracic Surgery Database Task Force 2017, 'The Society of Thoracic Surgeons Composite Score for Evaluating Esophagectomy for Esophageal Cancer', Annals of Thoracic Surgery, vol. 103, no. 5, pp. 1661-1667. https://doi.org/10.1016/j.athoracsur.2016.10.027
Chang, Andrew C. ; Kosinski, Andrzej S. ; Raymond, Daniel P. ; Magee, Mitchell J. ; DeCamp, Malcolm M. ; Farjah, Farhood ; Grogan, Eric L. ; Seder, Christopher W. ; Allen, Mark S. ; Blasberg, Justin D. ; Blackmon, Shanda H. ; Burfeind, William R. ; Cassivi, Stephen D. ; Park, Bernard J. ; Shahian, David M. ; Wormuth, David W. ; Han, Jane M. ; Wright, Cameron D. ; Fernandez, Felix G. ; Kozower, Benjamin D. ; The Society of Thoracic Surgeons General Thoracic Surgery Database Task Force. / The Society of Thoracic Surgeons Composite Score for Evaluating Esophagectomy for Esophageal Cancer. In: Annals of Thoracic Surgery. 2017 ; Vol. 103, No. 5. pp. 1661-1667.
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abstract = "Background The Society of Thoracic Surgeons (STS) has developed composite quality measures for cardiac surgical procedures and lobectomy for lung cancer. This study sought to develop a composite measure for esophagectomy for esophageal cancer. Methods The STS esophagectomy composite score is derived from two risk-adjusted outcomes: mortality and major complications. General Thoracic Surgery Database data were included from 2012 to 2014, and 95{\%} Bayesian credible intervals were established to determine “star” ratings. STS participants were compared with the National Inpatient Sample as a national benchmark (including non-STS participants). Results The study population included 4,321 patients who underwent esophagectomy from 167 participating centers. The operative mortality rate was 3.1{\%} (N = 135), and the major complication rate was 33.1{\%} (N = 1,429). Of the 167 participants, 70 reported an average yearly volume of five or more esophagectomies during the study period. With this threshold, reliability for the composite score was 0.58 (95{\%} credible interval, 0.41 to 0.72). Of these 70 participants, 5 (7.1{\%}) were three star, 63 (90.0{\%}) were two star, and 2 (2.9{\%}) were one star. A majority of STS participants, 58.1{\%} (N = 97), did not have sufficient volume to receive a reliable composite score. Benchmarked to the 2012 National Inpatient Sample cohort, STS General Thoracic Surgery Database participants have comparable discharge mortality rates and shorter postoperative lengths of stay. Conclusions STS has developed a quality measure for esophageal cancer surgical procedures based on a composite score of risk-adjusted operative mortality rates and major complications. The composite rating for esophagectomy has good reliability for programs performing an average of five procedures annually, although almost 60{\%} of participants are not eligible for a star rating because of lower procedure volumes.",
author = "Chang, {Andrew C.} and Kosinski, {Andrzej S.} and Raymond, {Daniel P.} and Magee, {Mitchell J.} and DeCamp, {Malcolm M.} and Farhood Farjah and Grogan, {Eric L.} and Seder, {Christopher W.} and Allen, {Mark S.} and Blasberg, {Justin D.} and Blackmon, {Shanda H.} and Burfeind, {William R.} and Cassivi, {Stephen D.} and Park, {Bernard J.} and Shahian, {David M.} and Wormuth, {David W.} and Han, {Jane M.} and Wright, {Cameron D.} and Fernandez, {Felix G.} and Kozower, {Benjamin D.} and {The Society of Thoracic Surgeons General Thoracic Surgery Database Task Force}",
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T1 - The Society of Thoracic Surgeons Composite Score for Evaluating Esophagectomy for Esophageal Cancer

AU - Chang, Andrew C.

AU - Kosinski, Andrzej S.

AU - Raymond, Daniel P.

AU - Magee, Mitchell J.

AU - DeCamp, Malcolm M.

AU - Farjah, Farhood

AU - Grogan, Eric L.

AU - Seder, Christopher W.

AU - Allen, Mark S.

AU - Blasberg, Justin D.

AU - Blackmon, Shanda H.

AU - Burfeind, William R.

AU - Cassivi, Stephen D.

AU - Park, Bernard J.

AU - Shahian, David M.

AU - Wormuth, David W.

AU - Han, Jane M.

AU - Wright, Cameron D.

AU - Fernandez, Felix G.

AU - Kozower, Benjamin D.

AU - The Society of Thoracic Surgeons General Thoracic Surgery Database Task Force

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Background The Society of Thoracic Surgeons (STS) has developed composite quality measures for cardiac surgical procedures and lobectomy for lung cancer. This study sought to develop a composite measure for esophagectomy for esophageal cancer. Methods The STS esophagectomy composite score is derived from two risk-adjusted outcomes: mortality and major complications. General Thoracic Surgery Database data were included from 2012 to 2014, and 95% Bayesian credible intervals were established to determine “star” ratings. STS participants were compared with the National Inpatient Sample as a national benchmark (including non-STS participants). Results The study population included 4,321 patients who underwent esophagectomy from 167 participating centers. The operative mortality rate was 3.1% (N = 135), and the major complication rate was 33.1% (N = 1,429). Of the 167 participants, 70 reported an average yearly volume of five or more esophagectomies during the study period. With this threshold, reliability for the composite score was 0.58 (95% credible interval, 0.41 to 0.72). Of these 70 participants, 5 (7.1%) were three star, 63 (90.0%) were two star, and 2 (2.9%) were one star. A majority of STS participants, 58.1% (N = 97), did not have sufficient volume to receive a reliable composite score. Benchmarked to the 2012 National Inpatient Sample cohort, STS General Thoracic Surgery Database participants have comparable discharge mortality rates and shorter postoperative lengths of stay. Conclusions STS has developed a quality measure for esophageal cancer surgical procedures based on a composite score of risk-adjusted operative mortality rates and major complications. The composite rating for esophagectomy has good reliability for programs performing an average of five procedures annually, although almost 60% of participants are not eligible for a star rating because of lower procedure volumes.

AB - Background The Society of Thoracic Surgeons (STS) has developed composite quality measures for cardiac surgical procedures and lobectomy for lung cancer. This study sought to develop a composite measure for esophagectomy for esophageal cancer. Methods The STS esophagectomy composite score is derived from two risk-adjusted outcomes: mortality and major complications. General Thoracic Surgery Database data were included from 2012 to 2014, and 95% Bayesian credible intervals were established to determine “star” ratings. STS participants were compared with the National Inpatient Sample as a national benchmark (including non-STS participants). Results The study population included 4,321 patients who underwent esophagectomy from 167 participating centers. The operative mortality rate was 3.1% (N = 135), and the major complication rate was 33.1% (N = 1,429). Of the 167 participants, 70 reported an average yearly volume of five or more esophagectomies during the study period. With this threshold, reliability for the composite score was 0.58 (95% credible interval, 0.41 to 0.72). Of these 70 participants, 5 (7.1%) were three star, 63 (90.0%) were two star, and 2 (2.9%) were one star. A majority of STS participants, 58.1% (N = 97), did not have sufficient volume to receive a reliable composite score. Benchmarked to the 2012 National Inpatient Sample cohort, STS General Thoracic Surgery Database participants have comparable discharge mortality rates and shorter postoperative lengths of stay. Conclusions STS has developed a quality measure for esophageal cancer surgical procedures based on a composite score of risk-adjusted operative mortality rates and major complications. The composite rating for esophagectomy has good reliability for programs performing an average of five procedures annually, although almost 60% of participants are not eligible for a star rating because of lower procedure volumes.

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