TY - JOUR
T1 - The Society of Thoracic Surgeons Composite Score for Evaluating Esophagectomy for Esophageal Cancer
AU - The Society of Thoracic Surgeons General Thoracic Surgery Database Task Force
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.
N1 - Publisher Copyright:
© 2017 The Society of Thoracic Surgeons
PY - 2017/5
Y1 - 2017/5
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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U2 - 10.1016/j.athoracsur.2016.10.027
DO - 10.1016/j.athoracsur.2016.10.027
M3 - Article
C2 - 28385375
AN - SCOPUS:85016597989
SN - 0003-4975
VL - 103
SP - 1661
EP - 1667
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 5
ER -