title: Preoperative assessment of lung cancer patients: evaluating guideline compliance (re-audit).
abstract: BACKGROUND
  Guidelines have been issued for the management of lung cancer patients in the United Kingdom. However, compliance with these national guidelines varies in different thoracic units in the country. We set out to evaluate our thoracic surgery practice and compliance with the national guidelines.
  
  
  METHODS
  An initial audit in 2011 showed deficiencies in practice, thus another audit was conducted to check for improvements in guideline compliance. A retrospective study was carried out over a 12-month period from January 2013 to January 2014 and included all patients who underwent radical surgical resection for lung cancer. Data were collected from computerized records.
  
  
  RESULTS
  Sixty-eight patients had radical surgery for lung cancer between January 2013 and January 2014. Four patients were excluded from the analysis due to incomplete records. Our results showed improvements in our practice compared to our initial audit. More patients underwent surgery within 4 weeks of computed tomography and positron-emission tomography scanning. An improvement was noticed in carbon monoxide transfer factor measurements. Areas for improvement include measurement of carbon monoxide transfer factor in all patients, a cardiology referral in patients at risk of cardiac complications, and the use of a global risk stratification model such as Thoracoscore.
  
  
  CONCLUSIONS
  Guideline-directed service delivery provision for lung cancer patients leads to improved outcomes. Our results show improvement in our practice compared to our initial audit. We aim to liaise with other thoracic surgery units to get feedback about their practice and any audits regarding adherence to the British Thoracic Society and National Institute for Health and Care Excellence guidelines.
authors.affiliation: New Cross Hospital, Wolverhampton, UK.
authors.forename: Parminderjit Kaur
authors.initials: PK
authors.lastname: Jayia
authors.affiliation: Department of Cardiothoracic Surgery, Heart and Lung Centre, Wolverhampton, UK mishrapk_25@yahoo.com.
authors.forename: Pankaj Kumar
authors.initials: PK
authors.lastname: Mishra
authors.affiliation: Medical Student, University of Birmingham, UK.
authors.forename: Raajul R
authors.initials: RR
authors.lastname: Shah
authors.affiliation: Medical Student, University of Birmingham, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Panayiotou
authors.affiliation: Department of Cardiothoracic Surgery, Heart and Lung Centre, Wolverhampton, UK.
authors.forename: Patrick
authors.initials: P
authors.lastname: Yiu
authors.affiliation: Department of Cardiothoracic Surgery, Heart and Lung Centre, Wolverhampton, UK.
authors.forename: Heyman
authors.initials: H
authors.lastname: Luckraz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019983:Guideline Adherence / Q000592:standards* / Q000706:statistics & numerical data*; D006801:Humans; D008175:Lung Neoplasms / Q000145:classification / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010820:Physicians / Q000592:standards*; D011013:Pneumonectomy / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data*; D049268:Positron-Emission Tomography; D017410:Practice Guidelines as Topic / Q000592:standards; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D006113:United Kingdom / Q000453:epidemiology
keywords: Lung neoplasms; Neoplasm staging; Pneumonectomy; Positron-emission tomography; Respiratory function tests; Tomography; X-ray computed