Division of Thoracic and Cardiovascular Surgery, Duke University Medical Center, Durham, North Carolina.
Duke Clinical Research Institute, Durham, North Carolina.
Ann Thorac Surg. 2019 Mar;107(3):897-902. doi: 10.1016/j.athoracsur.2018.07.059. Epub 2018 Sep 22.
Not all surgeons performing lobectomy in the United States report outcomes to The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD). We examined penetration, completeness, and representativeness of the STS GTSD for lobectomy in the Centers for Medicare and Medicaid Services (CMS) patient population.
The STS GTSD lobectomies from 2002 to 2013 were linked and matched to CMS data using a deterministic matching algorithm. Penetration at center- and patient-level were determined by the number of CMS lobectomy sites and patients, matched to STS GTSD data, divided by the total number of CMS lobectomy sites and patients, respectively. Completeness was defined as the ratio of lobectomies linked to STS GTSD data to the total number of lobectomies. Representativeness was determined by comparing outcomes for patients undergoing lobectomy at matched and unmatched STS GTSD sites.
A total of 9,569 centers were included in the study. Center level penetration steadily increased from 1.2% (10 of 859 sites) in 2002 to 25% (169 of 675 sites) in 2013. Patient-level penetration was highest, 38% (4,177 of 11,018), in 2013. Completeness at GTSD sites varied from 59% to 78% over the study period. Postoperative length of stay was longer for nonparticipants than for STS GTSD surgeons (median 6 versus 5 days, p < 0.001); 30-day mortality was higher for nonparticipants than for STS GTSD participants (3.3% versus 1.6%, p < 0.001).
Participation in the STS GTSD has increased over time, but penetration lags behind that of the other STS National Databases. The STS GTSD participants have superior observed perioperative outcomes for lobectomy compared with nonparticipants. Database participation may reflect high quality care, and ongoing efforts to increase surgeon participation in the STS GTSD should be continued.
并非所有在美国进行肺叶切除术的外科医生都会向胸外科医师学会普通胸外科数据库（STS GTSD）报告结果。我们研究了 STS GTSD 对医疗保险和医疗补助服务中心（CMS）患者人群中肺叶切除术的渗透程度、完整性和代表性。
使用确定性匹配算法将 2002 年至 2013 年 STS GTSD 的肺叶切除术与 CMS 数据进行链接和匹配。中心和患者层面的渗透程度通过与 STS GTSD 数据相匹配的 CMS 肺叶切除术部位和患者数量除以 CMS 肺叶切除术部位和患者总数来确定。完整性定义为与 STS GTSD 数据相链接的肺叶切除术数量与肺叶切除术总数的比值。代表性是通过比较在匹配和不匹配的 STS GTSD 站点接受肺叶切除术的患者的结果来确定的。
共有 9569 个中心纳入研究。中心层面的渗透程度从 2002 年的 1.2%（859 个部位中的 10 个）稳步上升到 2013 年的 25%（675 个部位中的 169 个）。患者层面的渗透程度最高，为 38%（11018 名患者中的 4177 名），出现在 2013 年。STS GTSD 站点的完整性在研究期间从 59%到 78%不等。非参与者的术后住院时间长于 STS GTSD 外科医生（中位数为 6 天与 5 天，p<0.001）；非参与者的 30 天死亡率高于 STS GTSD 参与者（3.3%与 1.6%，p<0.001）。
参与 STS GTSD 的人数随着时间的推移有所增加，但渗透率落后于其他 STS 国家数据库。与非参与者相比，STS GTSD 参与者的肺叶切除术围手术期观察结果更好。数据库参与可能反映了高质量的护理，应继续努力增加外科医生对 STS GTSD 的参与。
