Audit, quality control, and performance in thoracic surgery: a North American perspective

Area of Science:

• Healthcare Quality Measurement
• Thoracic Surgery Practice Evaluation
• Surgical Outcomes Analysis

Background:

• Health care quality is complex, often assessed through structure, process, and outcomes.
• Thoracic surgeons can benchmark their practices against national guidelines and large patient databases.
• Databases like STS National Databases and VA/ACS NSQIP provide valuable outcomes data.

Purpose of the Study:

• To explore the use of large patient databases for evaluating thoracic surgical practice quality.
• To highlight the role of national databases in comparing surgical outcomes and identifying areas for improvement.
• To discuss the application of these databases in risk-adjusted models for predicting surgical morbidity and mortality.

Main Methods:

• Utilizing outcomes data from major patient databases, including the STS National Databases and VA/ACS NSQIP.
• Examining the data integrity and comparative analysis capabilities of these large-scale surgical databases.
• Implementing the new STS composite quality score for Coronary Artery Bypass Grafting (CABG) which integrates outcome and practice data.

Main Results:

• Large patient databases offer high data integrity for surgical outcomes analysis.
• The STS composite quality score provides a calculated index for comparing provider performance against national averages.
• Risk-adjusted models derived from these databases serve as effective auditing tools for surgical morbidity and mortality.

Conclusions:

• Large patient databases are essential tools for thoracic surgeons to assess and improve practice quality.
• Continuous evolution of quality measures and database utilization will lead to enhanced patient care.
• Benchmarking against national data and utilizing predictive models are key strategies for advancing surgical quality.