Original article
General thoracic
The Society of Thoracic Surgeons General Thoracic Surgery Database: Establishing Generalizability to National Lung Cancer Resection Outcomes

Presented at the Forty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–Feb 1, 2012.
https://doi.org/10.1016/j.athoracsur.2012.03.054Get rights and content

Background

The Society of Thoracic Surgeons General Thoracic Surgery Database (GTDB) has demonstrated outstanding results for lung cancer resection. However, whether the GTDB results are generalizable nationwide is unknown. The purpose of this study was to establish the generalizability of the GTDB by comparing lung cancer resection results with those of the Nationwide Inpatient Sample (NIS), the largest all-payer inpatient database in the United States.

Methods

From 2002 to 2008, primary lung cancer resection outcomes were compared between the GTDB (n = 19,903) and the NIS (n = 246,469). Primary outcomes were the proportion of procedures performed nationally that were captured in the GTDB and differences in mortality rates and hospital length of stay. Observed differences in patient characteristics, operative procedures, and postoperative events were also analyzed.

Results

Annual GTDB lung cancer resection volume has increased over time but only captures an estimated 8% of resections performed nationally. The GTDB and NIS databases had similar median patient age (67 vs 68 years) and female sex (50% vs 49%), lobectomy was the most common procedure (64.7% vs 79.7%; p < 0.001), and pneumonectomies were uncommon (6.3% vs 7.2%; p < 0.001). Compared with NIS, the GTDB had significantly lower unadjusted discharge mortality rates (1.8% vs 3.0%), median length of stay (5.0 vs 7.0 days; p < 0.001), and postoperative pulmonary complication rates (18.5% vs 23.6%, p < 0.001).

Conclusions

The GTDB represents a small percentage of the lung cancer resections performed nationally and reports significantly lower mortality rates and shorter hospital length of stay than national results. The GTDB is not broadly generalizable. These results establish a benchmark for future GTDB comparisons and highlight the importance of increasing participation in the database.

Section snippets

Material and Methods

Records for patients undergoing lung resections with a diagnosis of lung cancer were extracted from the NIS data sets and the STS GTDB for the years 2002 to 2008. The University of Virginia Institutional Review Board exempted this study from review because it was not human subjects research owing to the lack of discrete patient identifiers and because the analyzed data were not exclusively collected for research purposes.

Results

A total of 19,903 patients were identified within the GTDB, and 246,469 patient records were extracted from the NIS (Table 1). Median patient age was similar in both databases (GTDB, 67 years; NIS, 68 years). Each database included a nearly equal number of men and women undergoing lung cancer resection. Among major comorbid disease states, nearly half of all patients presented with a preoperative history of hypertension, with a slightly higher prevalence among patients represented in the GTDB

Comment

The present study represents an important comparison of primary lung cancer resection rates and outcomes as reported within the STS GTSDB and the NIS. Our results demonstrate significant differences in patient-level data, procedure-level data, and outcomes between samples of the United States general thoracic surgical patient population between two leading clinical and administrative databases. Although the trend in the number of lung cancer resections captured within the NIS remained

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