International Collaboration Sets Stage for Better Lung Cancer Surgery Outcomes

“Our hope is that this collaboration will help identify best practices in lung cancer care in the US and Europe for better patient care worldwide,” said Felix G. Fernandez, MD, from Emory University, who is spearheading the effort with Alessandro Brunelli, MD, from St James's University Hospital in Leeds, England. “This collaboration has the potential to serve as an exemplar for global standardization of data collection.”

The project will utilize data from the STS General Thoracic Surgery Database (GTSD) and the ESTS Database. The GTSD is one of three components of the STS National Database, renowned especially for an Adult Cardiac Surgery Database (ACSD) that has become the gold standard for outcomes databases in the US. The ESTS Database was created as a joint activity with the European Association for Cardio-Thoracic Surgery.

Outcomes from both databases are risk-adjusted, which means that they take into account conditions that affect results, such as a patient’s age and existing health problems. Risk adjusted outcomes are important to measure a facility’s or surgeon’s performance, as well as to identify which patients will be best treated by a particular procedure.

The first task for STS and ESTS was to standardize the definitions and terminology used within their respective databases. “That task represents a huge undertaking because it requires setting up a common language regarding collection of clinical information,” explained Dr. Brunelli.

“By establishing a common language, we are combining our experiences to better understand each other’s processes and outcomes, which will foster clinical research collaboration across the continents and disseminate important findings faster,” added Dr. Fernandez.

STS and ESTS representatives have been holding informal discussions for several years, and during a recent collaborative process, common definitions were agreed upon by the two societies. Currently, members of the collaborative group are examining patterns of care and outcomes for lung cancer surgery from the two databases. Data and a draft manuscript have been circulated, and these outcomes will be the central topic of discussion at a gathering during the STS 51st Annual Meeting in January in San Diego.

“This project is particularly important in a specialty like thoracic surgery because we are a small community compared to other larger specialties. Increasing the pool of patient data on which to perform in-depth analyses is the only way we will be able to reliably assess our practices and produce robust guidelines to improve patient care and outcomes,” said Dr. Brunelli. “Future collaboration and integration of our two databases could generate significant new knowledge and has the potential to boost quality of care initiatives on both continents.”

Public Reporting of Surgical OutcomesIn addition to the collaboration with ESTS, STS is preparing for another milestone with the GTSD—public reporting. In early 2016, GTSD participants will have the opportunity to publicly report, on a voluntary basis, outcomes on lobectomy. ACSD outcomes have been publicly reported since 2010 and have evolved to include coronary artery bypass grafting surgery (CABG), aortic valve replacement (AVR), and AVR with CABG. Additionally, 25 Congenital Heart Surgery Database participants have signed up to publicly report their risk-adjusted operative mortality results in January 2015.

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Founded in 1964, The Society of Thoracic Surgeons is a not-for-profit organization representing more than 6,900 cardiothoracic surgeons, researchers, and allied health care professionals worldwide who are dedicated to ensuring the best possible outcomes for surgeries of the heart, lung, and esophagus, as well as other surgical procedures within the chest. The Society’s mission is to enhance the ability of cardiothoracic surgeons to provide the highest quality patient care through education, research, and advocacy.

The Annals of Thoracic Surgery is the official journal of STS and the Southern Thoracic Surgical Association.