J Thorac Cardiovasc Surg 2009;137:596
© 2009 The American Association for Thoracic Surgery
Discussion
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Dr J. Luketich (Pittsburgh, Pa). Dr Wright, that was an excellent presentation, and I congratulate you and your colleagues on your efforts to utilize the STS database, which includes close to 2000 cases of esophagectomy, to create a model of perioperative risk. One very important finding of your study, as you point out, is that thoracic surgeons participating in the STS database have a markedly lower mortality rate of only 2.5% compared with the Medicare database showing alarming mortality rates between 8% and 23%. I have several questions about your study.
What is the quality control of the data collection of the STS database? Are charts periodically audited by the STS during site visits? Along these lines, has your statistician voiced concerns about including the pulmonary function data, with fewer than 40% of patients having reported spirometry yet the finding of an overall correlation with outcome? And I wonder if you could comment specifically on which morbidities that the lower FEV1 was associated with. And has this influenced your practice? If you encounter a patient with an FEV1 < 60%, are you excluding them from esophagectomy?
Dr Wright (Boston, Mass). Thank you for that question. Currently, the STS does not audit the data in their database. This is a new database, in existence for only 6 years. You have to remember that the cardiac database, in existence for over 15 . . . [Full Text of this Article]
Copyright © 2009 by The American Association for Thoracic Surgery.
