title: The Society of Thoracic Surgeons Composite Score for Rating Program Performance for Lobectomy for Lung Cancer.
abstract: BACKGROUND
  The Society of Thoracic Surgeons (STS) has developed multidimensional composite quality measures for common cardiac surgery procedures. This first composite measure for general thoracic surgery evaluates STS participant performance for lobectomy in lung cancer patients.
  
  
  METHODS
  The STS lobectomy composite score is composed of two outcomes: risk-adjusted mortality; and any-or-none, risk-adjusted major complications. General Thoracic Surgery Database data were included from 2011 to 2014 to provide adequate sample size, and 95% Bayesian credible intervals were used to determine "star ratings." The STS participants were also compared with national benchmarks (including non-STS participants) using the National Inpatient Sample. Comparisons of discharge mortality, postoperative length of stay, and percent of stage I lung cancers resected using minimally invasive approaches are not included in star ratings but will be reported to participants in STS feedback reports.
  
  
  RESULTS
  The study population included 20,657 lobectomy patients from 231 participating centers. Operative mortality was 1.5%, major complication rate was 9.6%, and median postoperative length of stay was 4 days. Risk-adjusted mortality and major complication rates varied threefold from highest performing (three-star) to lowest performing (one-star) programs. Approximately 5% of participants were one-star, 7% were three-star, and 88% were two-star programs.
  
  
  CONCLUSIONS
  The STS has developed the first general thoracic surgery quality composite measure to compare programs performing lobectomy for lung cancer. This measure will be used for quality assessment and provider feedback, and will be made available for voluntary public reporting.
authors.affiliation: University of Virginia, Charlottesville, Virginia. Electronic address: bdk8g@virginia.edu.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Kozower
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Brien
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Andrzej S
authors.initials: AS
authors.lastname: Kosinski
authors.affiliation: Medical City Dallas Hospital, Dallas, Texas.
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Magee
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Rachel
authors.initials: R
authors.lastname: Dokholyan
authors.affiliation: All Children's Hospital, John Hopkins University, St. Petersburg, Florida.
authors.forename: Jeffery P
authors.initials: JP
authors.lastname: Jacobs
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: David M
authors.initials: DM
authors.lastname: Shahian
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Cameron D
authors.initials: CD
authors.lastname: Wright
authors.affiliation: Emory University, Atlanta, Georgia.
authors.forename: Felix G
authors.initials: FG
authors.lastname: Fernandez
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011013:Pneumonectomy / Q000401:mortality / Q000706:statistics & numerical data; D015397:Program Evaluation; D019984:Quality Indicators, Health Care; D012955:Societies, Medical; D013903:Thoracic Surgery; D020775:Thoracic Surgery, Video-Assisted; D014481:United States