Advancing Surgical Quality: Performance Measures and Risk Adjustment in Modern Thoracic Surgery

Thoracic surgery has transitioned from simple mortality tracking to more complex, risk-adjusted performance metrics. This article reviews this evolution, applying a structure-process-outcome framework to detail current performance indicators in the field. It then discusses how large registries and advanced statistical methods facilitate fair benchmarking and point-of-care decision support, while also addressing limitations, including incomplete data and the absence of social risk considerations. It concludes by exploring future directions, including frailty adjustment, equity-focused modeling, and artificial intelligence-driven quality improvement.