Thoracic surgery report shows reduction in operative mortality rates
Dendrite Clinical Systems and the Society for Cardiothoracic surgery (SCTS) have released a new report that demonstrates importance collecting and analysing clinical data. The report entitled, 'National Thoracic Surgery Activity & Outcomes Report 2011", includes more than 400,000 operations from 1980 to 2010 and includes hospital-specific data for the past three years. Specifically, the new audit shows the number of lung cancer patients benefiting from surgery has increased by 60%, while the operative mortality rate has decreased in recent years.
Increased rates of lung cancer surgery have been linked to improved survival for patients. Although the surgery carries risks, studies have shown that for every person who dies as a result of surgery, 35 people who would otherwise have died from their cancer are still alive five years on, said Professor David Taggart, President of SCTS. The potential to improve the outlook for this group is huge if we continue the improvements made in the past few years. If we could get the rate of operations across the country up to the standard of the best performing areas then at least a thousand additional lives could be saved each year.
Although the number of patients undergoing primary lung cancer resection had remained relatively unchanged between 1980 and 2006 (between 3,000 and 4,000 operations a year), the number of operations has increased each year 5,265 in 2010. Despite this rise, operative mortality rates have decrease over the last decade from 3.8% to 2.1%.
Not only does the report provide outcomes data, but it allows thoracic specialist to examine the variations between units and therefore improving planning strategy (ie. manpower, capacity, equipment, training and infrastructure) within thoracic surgical hospitals.
Previously, many patients would have been denied surgery due to age and co-morbidity, and the increase procedures is a result of surgeons and the wider lung cancer team to offer them surgery as opposed to other therapies. It is believed that the appointment of more consultant thoracic surgeons has led to many of these changes by increasing access to thoracic surgery for patients. A 2002 initiative to appoint United Kingdom trainees with a career path leading to pure general thoracic surgery will have facilitated this increase in appointments. The regular input of thoracic surgeons into lung cancer multi-disciplinary team meetings will have increased the number of patients having access to a discussion about surgery for their disease and more patients being referred for a surgical opinion.
This audit shows that decisions by the SCTS and Royal College of Surgeons to introduce specialist thoracic surgery training a decade ago are starting to bear fruit, said Professor Norman Williams, President of the Royal College of Surgeons. The first of the consultants trained in this way are now coming through the system and more hospitals are appointing lung specialist surgeons. The presence of these new surgeons is enabling the teams who care for lung cancer patients to make more confident decisions to offer surgery.
The report also shows a steady increase in the use of minimally invasive surgery in many aspects of thoracic surgical practice. In the last two years of data collection the number of lobectomies for primary lung cancer being carried out using minimally invasive techniques rose from 7.0% to 13.8%, a reflection on increased opportunities for training and a belief in efficacy and safety of the technique amongst surgeons.
This report demonstrates that investing in dedicated thoracic surgeons has resulted in more lung cancer patients receiving surgery and having a much better chance of an uncomplicated recovery, said Dr Peter Walton, Managing Director of Dendrite. It is encouraging to see the continuing value clinical governance delivers, especially in terms of improving long-term patient outcomes.