title: The Society of Thoracic Surgeons Lung Cancer Resection Risk Model: Higher Quality Data and Superior Outcomes.
abstract: BACKGROUND
  The Society of Thoracic Surgeons (STS) creates risk-adjustment models for common cardiothoracic operations for quality improvement purposes. Our aim was to update the lung cancer resection risk model utilizing the STS General Thoracic Surgery Database (GTSD) with a larger and more contemporary cohort.
  
  
  METHODS
  We queried the STS GTSD for all surgical resections of lung cancers from January 1, 2012, through December 31, 2014. Logistic regression was used to create three risk models for adverse events: operative mortality, major morbidity, and composite mortality and major morbidity.
  
  
  RESULTS
  In all, 27,844 lung cancer resections were performed at 231 centers; 62% (n = 17,153) were performed by thoracoscopy. The mortality rate was 1.4% (n = 401), major morbidity rate was 9.1% (n = 2,545), and the composite rate was 9.5% (n = 2,654). Predictors of mortality included age, being male, forced expiratory volume in 1 second, body mass index, cerebrovascular disease, steroids, coronary artery disease, peripheral vascular disease, renal dysfunction, Zubrod score, American Society of Anesthesiologists rating, thoracotomy approach, induction therapy, reoperation, tumor stage, and greater extent of resection (all p < 0.05). For major morbidity and the composite measure, cigarette smoking becomes a risk factor whereas stage, renal dysfunction, congestive heart failure, and cerebrovascular disease lose significance.
  
  
  CONCLUSIONS
  Operative mortality and complication rates are low for lung cancer resection among surgeons participating in the GTSD. Risk factors from the prior lung cancer resection model are refined, and new risk factors such as prior thoracic surgery are identified. The GTSD risk models continue to evolve as more centers report and data are audited for quality assurance.
authors.affiliation: Emory University, Atlanta, Georgia. Electronic address: felix.fernandez@emoryhealthcare.org.
authors.forename: Felix G
authors.initials: FG
authors.lastname: Fernandez
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Andrzej S
authors.initials: AS
authors.lastname: Kosinski
authors.affiliation: St. Luke's Health Network, Allentown, Pennsylvania.
authors.forename: William
authors.initials: W
authors.lastname: Burfeind
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Bernard
authors.initials: B
authors.lastname: Park
authors.affiliation: Northwestern University, Chicago, Illinois.
authors.forename: Malcolm M
authors.initials: MM
authors.lastname: DeCamp
authors.affiliation: Rush University, Chicago, Illinois.
authors.forename: Christopher
authors.initials: C
authors.lastname: Seder
authors.affiliation: Georgetown University, Washington, DC.
authors.forename: Blair
authors.initials: B
authors.lastname: Marshall
authors.affiliation: Medical City Hospital, Dallas, Texas.
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Magee
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Cameron D
authors.initials: CD
authors.lastname: Wright
authors.affiliation: University of Virginia, Charlottesville, Virginia.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Kozower
mesh_terms: D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D015233:Models, Statistical; D011013:Pneumonectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D020379:Risk Adjustment / Q000379:methods*; D012307:Risk Factors; D012737:Sex Factors; D012955:Societies, Medical; D015996:Survival Rate / Q000639:trends; D013903:Thoracic Surgery; D013906:Thoracoscopy / Q000379:methods; D014481:United States / Q000453:epidemiology