From trees to wood and back: perspective on clinical data analysis in thoracic surgery

General thoracic surgery has been slow to embrace advanced statistical techniques to assess outcome and direct future therapy to individual patients (the "trees") based on aggregating data and discovering informative patterns in them (the "wood"). This is due in part to the nature and complexity of the practice. However, methods exist that deal with problems of small numbers, variable case volume, and heterogeneity of patients, diseases, and therapies. For effective analysis of these multiple variables, modern strategies must be used and pitfalls avoided. For generating new knowledge about appropriateness of therapy, the focus of analyses must include long-term outcome. Quality improvement efforts may be assisted by in-depth analysis of short-term outcome from a select number of centers to inform future universal efforts. Ultimately, these results need to feed back to improved management of the individual patient.