Efficiency Quality Index for Lobectomy - Developing a Quality Assessment Tool Scoring System

This study aims to develop an Efficiency Quality Index (EQI) to summarize and monitor the quality of care in a thoracic surgery service.

The EQI comprised fourteen indicators (INDs): Operating Room (OR) Procedure Time, Total OR Time, Observed vs Expected Discharge, Rate of Discharge After 72 H, Readmission, Surgical Site Infection, 30-D Mortality, OR Transfusions, Emergent Conversions, Pneumonia, Unanticipated Post-Op Procedure, Major Complication, Prolonged Air Leak, and Compliance with the Lymph Node Dissections. A total of 100 points was distributed among the INDs, with each assigned a maximum point value ranging from 4 to 16, based on clinical relevance as determined by thoracic surgeons. EQI scores were calculated quarterly using data from minimally invasive lobectomies performed between January 2019 and December 2024. Each IND was scored according to performance relative to internal and Society of Thoracic Surgeons benchmarks, with maximum point awarded in 25% increments. A total score of 80 indicated performance at the national standard.

EQI scores varied significantly, ranging from 50.0 (Q4-2020) to 89.2 (Q1-2022). The quarterly analysis identified INDs that were driving lower scores, prompting targeted quality improvement efforts. Indicator weighting reflected surgeons' prioritization of clinical significance and provider perspective.

The proposed EQI, developed and validated by thoracic surgeons, provides a structured tool for tracking quality trends and starting data-driven quality improvement initiatives. It enables a focused, clinically relevant approach to performance monitoring and supports sustained quality efforts in thoracic surgical care.