Patient-centered quality indicators for pulmonary resection.
BACKGROUND
Quality of care is increasingly scrutinized. However, no standard quality measures exist for surgical care of patients undergoing pulmonary resection.


METHODS
Our thoracic surgical team developed a set of patient-centered quality of care measures specific to patients undergoing pulmonary resection. Measures were chosen that demonstrated evidence-based preoperative assessment, adequate mediastinal staging, and interventions to prevent and expeditiously treat postoperative morbidity. Medical records of all patients undergoing pulmonary resection in 2005 were analyzed.


RESULTS
In all, 606 patients (men:women = 330:276) underwent 628 pulmonary resections. Median age was 65.8 years (range, 2 to 93). Operative mortality was 2.1%. Pulmonary function testing within 1 year before surgery was documented in 74.2%. Electrocardiogram within 90 days before surgery was documented in 81.6% of patients 50 years and older. Smoking history was documented in all patients, and smoking cessation consultation was offered to 85.7% of current smokers. Deep venous thrombosis prophylaxis was implemented in 99.7%. Mediastinal staging was documented in 94.0% of patients undergoing lung cancer resection (n = 333). Postoperatively, 92.4% of patients used incentive spirometry. Atrial fibrillation treatment occurred within 45 minutes of onset in 70.5%. Postoperative analog pain scores were above 6 in only 7.4% of assessments; treatment and reassessment occurred within 2 hours in 81.0%. Follow-up planning was documented at hospital discharge in 100%. No National Quality Forum "never events" occurred.


CONCLUSIONS
Patient-centered and clinically relevant quality measures can be developed and evaluated in general thoracic surgery. This panel of quality indicators highlights and guide areas for potential improvement in the care of patients undergoing pulmonary resection.
Cassivi
Stephen D
SD
Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA. cassivi.stephen@mayo.edu
Allen
Mark S
MS
Vanderwaerdt
Gregg D
GD
Ewoldt
Lori L
LL
Cordes
Mary E
ME
Wigle
Dennis A
DA
Nichols
Francis C
FC
Pairolero
Peter C
PC
Deschamps
Claude
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008482:Mediastinum / Q000473:pathology; D008499:Medical Records; D008875:Middle Aged; D009367:Neoplasm Staging; D010149:Postoperative Pain; D018802:Patient-Centered Care / Q000379:methods*; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D011787:Quality of Health Care; D016540:Smoking Cessation; D020246:Venous Thrombosis / Q000517:prevention & control