title: Lessons learned from the European thoracic surgery database: the Composite Performance Score.
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.
authors.affiliation: Database Committee, European Society of Thoracic Surgery, Div. Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy. brunellialex@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Brunelli
authors.forename: G
authors.initials: G
authors.lastname: Rocco
authors.forename: D
authors.initials: D
authors.lastname: Van Raemdonck
authors.forename: G
authors.initials: G
authors.lastname: Varela
authors.forename: M
authors.initials: M
authors.lastname: Dahan
mesh_terms: D019985:Benchmarking; D016208:Databases, Factual; D005060:Europe; D006801:Humans; D016015:Logistic Models; D008171:Lung Diseases / Q000601:surgery*; D011013:Pneumonectomy / Q000401:mortality / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012016:Reference Values; D012042:Registries; D013903:Thoracic Surgery / Q000592:standards* / Q000706:statistics & numerical data