A new report from the Society for Cardiothoracic Surgery in Great Britain & Ireland (published by Dendrite Clinical Systems), has for the first time recorded the variations in activity and surgical approaches between thoracic surgical units in the United Kingdom and Ireland. Presented at the recent Annual Meeting of the Society for Cardiothoracic Surgery in Great Britain & Ireland (Edinburgh, Scotland), The First National Thoracic Database Report 2008, is the first stage in an attempt to report clinically audited data for thoracic surgery affecting all the organs within the chest (lung and oesophagus), with the exception of the heart.
This First National Thoracic Database Report is the first time data from the National Thoracic Registry has been put together in a comprehensive report, commented UK Thoracic Surgical Audit Lead, Mr Richard Page, Consultant Thoracic Surgeon & Associate Medical Director at the Cardiothoracic Centre, Liverpool. The report puts into context how our approach to thoracic surgery has evolved over the years, and demonstrates that the results of thoracic surgery in the UK have improved over time and compare very favourably with international standards. I believe it is of great educational value.
The purpose of the The First National Thoracic Database Report 2008 is not only to report the number/type of procedures, but also to highlight the differing approaches to thoracic surgery between individual hospitals. The report includes:
This comprehensive, 88-page report provides an overview from 25 years of national activity (1980-2005), detailing unit specific activity for a three-year period (2002-2005) and provides procedural activity in the following areas:
Importantly, the report highlights several different approaches to treating thoracic disease, which clearly reflects the differing philosophical approaches to some complex and difficult diseases. For instance, the Registry highlights a clear trend to a reduction in the proportion of pneumonectomies, implying recognition of the dangers associated with the procedure and a better selection of surgical patients.
One of the most important messages from my point of view is that over the years we have got much better at selecting our patients for lung cancer surgery. For instance twenty-five years ago when a patient was taken to theatre for a lung cancer operation there was a one in four chance that the cancer could not be removed - that would seem horrendous by todays standards. This dramatic reduction in the open and close rate for lung cancer operations, implies a better understanding of the place of surgery for lung cancer, especially with more accurate pre-operative staging since the introduction of computed tomography in the late 1980s, added Mr Page.
The report also shows the variations and changes in practice over the years (the majority of procedures for oesophageal cancer are now performed by upper GI surgeons), as well as how technological developments have changed practice. For example, video assisted thoracic surgery procedures, as a proportion of the total workload, increased from approximately 6% in 1981 to nearly 30% in 2004-2005.
The information contained within the report forms the basis of effective clinical governance and will serve to improve the outcomes for patients, as well as assist in the planning and implementation of future thoracic surgical services. By reporting procedure type/s and the locations where in the surgery is carried out, it is hoped this first national audit will lead to better organisation of services, Mr Page commented. For example, there are more thoracic procedures performed in some parts of the country than others, for whatever reason, and that is a very powerful argument for extra resources. I hope the report highlights that need.
The first report contains no patient-specific details and is therefore not designed to compare and measure surgical outcomes between hospitals, but rather variations in surgical activity. However, the Society has agreed a minimum dataset to allow for a report on such issues within the United Kingdom and Ireland for thoracic surgical practice.
The dataset we have agreed has been established for some four or five years and is easy to understand and uncomplicated. If you make it too complicated one runs the risk of not getting the reports in at all and if you make it too simple the data is not very useful, so it is about striking a balance. It concentrates on the surgical management of lung cancer. Of course there is a temptation to expand the dataset and to look in detail at more diseases, but at first it is best to establish the process so people understand what we want and further down the road there may well be a case for expanding the dataset. In this first report we have shown what can be done and over time we hope to develop a more comprehensive report, Mr Page concluded.
Dr Peter Walton, Managing Director of Dendrite Clinical Systems, commented, We are delighted to publish The First National Thoracic Surgery Report, which we believe will be of tremendous educational value to both the Society, its members and other healthcare professionals involved in thoracic surgical services. I would like to thank the SCTS for their support and in particular, Mr Page, for the enthusiasm, dedication and determination he has shown in producing the report. I would also like to pay tribute to all the contributors for their endeavours, without whom this report would not have been possible. We look forward to working with the SCTS in the future and publishing additional reports that will provide even greater insights into thoracic surgery in the UK and Ireland.
The highlights of the report were presented at the recent Annual Meeting of the Society for Cardiothoracic Surgery in Great Britain & Ireland, in Edinburgh, Scotland, held 9thC11th March 2008.
A copy of the report is available to download @: http://www.scts.org/sections/audit/thoracic/index.html
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