title: Variation in Pulmonary Resection Practices Between The Society of Thoracic Surgeons and the European Society of Thoracic Surgeons General Thoracic Surgery Databases.
abstract: BACKGROUND
  Clinical guidelines are created to reduce variation in care practices, with the goal of improving patient outcomes. There is currently no international consensus on best practices for pulmonary resection. Our aim was to evaluate variation in treatment patterns and outcomes for pulmonary resection by comparing The Society of Thoracic Surgeons (STS) and the European Society of Thoracic Surgery (ESTS) general thoracic surgery databases (GTSDs).
  
  
  METHODS
  An international collaboration was established between the STS and ESTS GTSD task forces. Patients who underwent pulmonary resection between 2010 and 2013 were identified from the 2 databases. Data on patient demographics, disease characteristics, treatment strategies, morbidity, and mortality were compared.
  
  
  RESULTS
  There were 78,212 lung resections captured in the STS (n = 47,539) and ESTS databases (n = 30,673). Patients from the STS database were more likely to be of the female sex, have no pathologic N2 disease, have had previous cardiothoracic operations, and have received preoperative thoracic irradiation compared with patients from the ESTS database. In addition, patients from the STS database were more likely to have undergone a thoracoscopic operation and have received a sublobar resection. Although there was an increased risk of reintubation, atrial arrhythmias, and return to the operating room in the STS patients, the mean hospital length of stay was shorter than in patients from the ESTS database, regardless of operation performed. Thirty-day mortality was higher in the STS patients for wedge resection (p < 0.001) but lower for lobectomy (p < 0.001) and pneumonectomy (p < 0.001) compared with the ESTS patients.
  
  
  CONCLUSIONS
  Differences exists in patient population, procedures performed, and outcomes for pulmonary resections between the STS and ESTS databases, suggesting an opportunity for quality improvement initiatives.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, Illinois. Electronic address: christopher_w_seder@rush.edu.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Seder
authors.affiliation: Unit of Thoracic Surgery, Ospedali Riuniti Ancona, Ancona, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Salati
authors.affiliation: Department of Surgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Kozower
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Cameron D
authors.initials: CD
authors.lastname: Wright
authors.affiliation: Department of Thoracic Surgery, Nouvel Hospital Civil, Strasbourg, France.
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Falcoz
authors.affiliation: Department of Thoracic Surgery, St. James University Hospital, Leeds, United Kingdom.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Brunelli
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Felix G
authors.initials: FG
authors.lastname: Fernandez
mesh_terms: D000328:Adult; D026683:Advisory Committees; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D015897:Comorbidity; D016208:Databases, Factual; D005060:Europe; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011013:Pneumonectomy / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality; D017410:Practice Guidelines as Topic; D012955:Societies, Medical; D013903:Thoracic Surgery / Q000458:organization & administration*; D020775:Thoracic Surgery, Video-Assisted / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States
chemical_list: D000970:Antineoplastic Agents