Ann Thorac Surg. 2017 May;103(5):1661-1667. doi: 10.1016/j.athoracsur.2016.10.027. Epub 2017 Apr 3.
The Society of Thoracic Surgeons (STS) has developed composite quality measures for cardiac surgical procedures and lobectomy for lung cancer. This study sought to develop a composite measure for esophagectomy for esophageal cancer.
The STS esophagectomy composite score is derived from two risk-adjusted outcomes: mortality and major complications. General Thoracic Surgery Database data were included from 2012 to 2014, and 95% Bayesian credible intervals were established to determine "star" ratings. STS participants were compared with the National Inpatient Sample as a national benchmark (including non-STS participants).
The study population included 4,321 patients who underwent esophagectomy from 167 participating centers. The operative mortality rate was 3.1% (N = 135), and the major complication rate was 33.1% (N = 1,429). Of the 167 participants, 70 reported an average yearly volume of five or more esophagectomies during the study period. With this threshold, reliability for the composite score was 0.58 (95% credible interval, 0.41 to 0.72). Of these 70 participants, 5 (7.1%) were three star, 63 (90.0%) were two star, and 2 (2.9%) were one star. A majority of STS participants, 58.1% (N = 97), did not have sufficient volume to receive a reliable composite score. Benchmarked to the 2012 National Inpatient Sample cohort, STS General Thoracic Surgery Database participants have comparable discharge mortality rates and shorter postoperative lengths of stay.
STS has developed a quality measure for esophageal cancer surgical procedures based on a composite score of risk-adjusted operative mortality rates and major complications. The composite rating for esophagectomy has good reliability for programs performing an average of five procedures annually, although almost 60% of participants are not eligible for a star rating because of lower procedure volumes.
胸外科医师协会（STS）已制定了心脏外科手术和肺癌肺叶切除术的综合质量指标。本研究旨在制定食管癌食管切除术的综合指标。
STS食管切除术综合评分源自两个风险调整后的结果：死亡率和主要并发症。纳入2012年至2014年普通胸外科数据库的数据，并建立95%贝叶斯可信区间以确定“星级”评定。将STS参与者与作为国家基准的全国住院患者样本（包括非STS参与者）进行比较。
研究人群包括来自167个参与中心的4321例行食管切除术的患者。手术死亡率为3.1%（N = 135），主要并发症发生率为33.1%（N = 1429）。在167名参与者中，70名报告在研究期间平均每年进行5例或更多例食管切除术。以此为阈值，综合评分的可靠性为0.58（95%可信区间为0.41至0.72）。在这70名参与者中，5名（7.1%）为三星级，63名（90.0%）为二星级，2名（2.9%）为一星级。大多数STS参与者，即58.1%（N = 97），手术量不足，无法获得可靠的综合评分。与2012年全国住院患者样本队列相比，STS普通胸外科数据库参与者的出院死亡率相当，术后住院时间更短。
STS基于风险调整后的手术死亡率和主要并发症的综合评分，制定了食管癌手术的质量指标。对于每年平均进行5例手术的项目，食管切除术的综合评级具有良好的可靠性，尽管近60%的参与者因手术量较低而无资格获得星级评定。
