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Lessons learned from the European thoracic surgery database: The composite performance score

  • Author Footnotes
    1 On behalf of the ‘ESTS Database Committee’.
    A. Brunelli
    Correspondence
    Corresponding author. Div. Thoracic Surgery, Ospedali Riuniti Ancona, 60020 Ancona, Italy. Tel.: +39 715964433; fax: +39 715964481.
    Footnotes
    1 On behalf of the ‘ESTS Database Committee’.
    Affiliations
    European Society of Thoracic Surgery, Database Committee, Italy
    Search for articles by this author
  • Author Footnotes
    1 On behalf of the ‘ESTS Database Committee’.
    G. Rocco
    Footnotes
    1 On behalf of the ‘ESTS Database Committee’.
    Affiliations
    European Society of Thoracic Surgery, Database Committee, Italy
    Search for articles by this author
  • Author Footnotes
    1 On behalf of the ‘ESTS Database Committee’.
    D. Van Raemdonck
    Footnotes
    1 On behalf of the ‘ESTS Database Committee’.
    Affiliations
    European Society of Thoracic Surgery, Database Committee, Italy
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  • Author Footnotes
    1 On behalf of the ‘ESTS Database Committee’.
    G. Varela
    Footnotes
    1 On behalf of the ‘ESTS Database Committee’.
    Affiliations
    European Society of Thoracic Surgery, Database Committee, Italy
    Search for articles by this author
  • Author Footnotes
    1 On behalf of the ‘ESTS Database Committee’.
    M. Dahan
    Footnotes
    1 On behalf of the ‘ESTS Database Committee’.
    Affiliations
    European Society of Thoracic Surgery, Database Committee, Italy
    Search for articles by this author
  • Author Footnotes
    1 On behalf of the ‘ESTS Database Committee’.

      Abstract

      Background

      This study reports the methods used to review the Composite Performance Score (CPS) along with a reference table, which will be used in the upcoming ESTS Quality Certification Program.

      Methods

      Data from 4303 patients who underwent pulmonary resection (July 2007–January 2010) were captured in the ESTS database and used for the present analysis. Only patients submitted from units contributing at least 100 consecutive lung resections were used for developing the score.
      According to the best available evidence the following measures were selected for each surgical domain: preoperative care (1. % of DLCO measurement in patients submitted to major anatomic resections; 2. % of preoperative invasive mediastinal staging in patients with clinically suspicious N2 disease), operative care (% of systematic lymph node dissection), outcomes (risk-adjusted cardiopulmonary morbidity and mortality rates). Morbidity and mortality risk-models were developed by logistic regression and validated by bootstrap analyses. Individual processes and outcomes scores were rescaled according to their standard deviations and summed to generate the CPS. Units were rated accordingly and a percentile reference table was produced.

      Results

      Risk-adjusted survival and absence of morbidity rates varied from 91.5% to 100%, and from 50.2% to 97.5%, respectively. CPS ranged from −4.038 to 1.24. The 50% percentile of CPS corresponded to 0.404.

      Conclusions

      A revised Composite Performance Score was developed and a reference table presented to be used as a benchmark for the ESTS Quality Certification program.

      Keywords

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