The Society of Thoracic Surgeons Composite Score Rating for Pulmonary Resection for Lung Cancer

Abstract Background The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database (GTSD) has developed composite quality measures for lobectomy and esophagectomy. We sought to develop a composite measure including all resections for lung cancer. Methods The STS lung cancer composite score is based on two outcomes: risk-adjusted mortality and morbidity. General Thoracic Surgery Database (GTSD) data were included from 1/2015 – 12/2017. “Star ratings” were created for centers with ≥ 30 cases using 95% Bayesian credible intervals. The Bayesian model was performed with and without inclusion of minimally invasive approach to assess the impact of approach on the composite measure. Results The study population included 38,461 patients from 256 centers. Overall operative mortality was 1.3% (495/38,461); Major complication rate was 7.9% (3,045/38,461). Median nodes examined was 10 (IQR 5-16); Median nodal stations sampled was 4 (IQR 3-5). Positive resection margins were identified in 3.7% (1,420/38,461). 214 centers with ≥ 30 cases were assigned star ratings. There were 7 one-star, 194 two-star and 13 three-star programs. 70.6% of resections were performed through a minimally invasive approach. Inclusion of minimally invasive approach, which was adjusted for in previous models, altered the star ratings for 3% (6/214) of programs. Conclusions Participants in the STS GTSD perform lung cancer resection with low morbidity and mortality. Lymph node data suggest participants are meeting contemporary staging standards. There is wide variability among participants in application of minimally invasive approaches. Risk adjustment for approach alters ratings in 3% of participants.