Cleveland Clinic Thoracic Surgery Group

Hospital associated with this Participant

Cleveland Clinic
Cleveland, OH

Performance for Lobectomy Compared to STS and National Outcomes*

* These NIS data are the most recent data available at this time. There are more lobectomy for lung cancer patients in a single year of NIS data than in the GTSD, so a decision was made to use 3 years of STS GTSD data.

Lobectomy for Lung Cancer Composite Measure Results

Year	Overall Composite Score**	Absence of Mortality	Absence of Major Complication
January 2016 – December 2018	Overall Composite Rating 98.9%	Absence of Mortality Rating 99.2%	Absence of Morbidity Rating 95.1%

Esophagectomy Composite Measure Results

Year	Overall Composite Score**	Absence of Mortality	Absence of Major Complication
January 2016 – December 2018	Esophogectomy Overall Composite Rating 95.1%	Esophogectomy Absence of Mortality Rating 98.5%	Esophogectomy Absence of Morbidity Rating 82.7%

Discharge Mortality Percent

0.0%

Discharge Mortality Lower 95 CI

0.0%

Discharge Mortality Upper 95 CI

0.7%

STS Discharge Mortality Percent

0.6%

NIS Discharge Mortality Percent

1.3%

98.9%

Overall Composite Score

99.2%

Absence of Mortality Score

95.1%

Absence of Morbidity Score

NIS PLOS Median

4.80

PLOS Lower Quartile

3.00

PLOS Median

4.00

PLOS Upper Quartile

5.00

STS PLOS Median

4.00

95.1%

Esophogectomy Overall Composite Score

Esophogectomy Absence of Morbidity Score

82.7%

Esophogectomy Absence of Mortality Score

98.5%

**Lobectomy for Lung Cancer Overall Composite Score represents two domain scores in a single number:

Absence of Operative Mortality: Percentage of patients [risk-adjusted] who did not experience operative mortality. Operative mortality is defined as death during the same hospitalization as surgery or after discharge but within 30 days of the procedure.
Absence of Major Morbidity: Percentage of patients [risk-adjusted] who did not experience any major morbidity. These are: 1) pneumonia; 2) acute respiratory distress syndrome; 3) bronchopleural fistula; 4) pulmonary embolus; 5) initial ventilator support > 48 hours; 6) reintubation/respiratory failure; 7) tracheostomy; 8) myocardial infarction; 9) unexpected return to the operating room.

*** Esophagectomy Overall Composite Score represents two domain scores in a single number:

Absence of Operative Mortality: Percentage of patients [risk-adjusted] who did not experience operative mortality. Operative mortality is defined as death during the same hospitalization as surgery or after discharge but within 30 days of the procedure.
Absence of Major Morbidity: Percentage of patients [risk-adjusted] who did not experience any major morbidity. These are: 1) pneumonia; 2) recurrent laryngeal nerve paresis; 3) anastomotic leak requiring medical treatment only; 4) initial ventilator support > 48 hours; 5) reintubation/respiratory failure; 6) unexpected return to the operating room; 7) new renal failure per RIFLE criteria.

Bayesian Credible Intervals: The Bayesian credible interval shows the range in which the participant’s true score is likely to lie. STS uses 95% credible intervals. Unlike traditional confidence intervals, the Bayesian credible interval has an intuitive probability interpretation. Based on the observed data it can be said that it is 95% likely that the true proportion falls within the upper and lower limits of the 95% credible interval.

Detailed information regarding the lobectomy for lung cancer composite measure is provided in the following manuscript:
Kozower BD, O’Brien SM, Kosinski A, Magee MJ, Dokholyan R, Jacobs JP, Shahian DM, Wright CD, Fernandez FG. The Society of Thoracic Surgeons composite score for rating program performance for lobectomy for lung cancer. Ann Thorac Surg. 2016; 101(4):1379-87. DOI: http://dx.doi.org/10.1016/j.athoracsur.2015.10.081