LCCOP Outlier Advice & Support Documents
The outlier management and support document has been updated and reviewed by the the SCTS thoracic subcommittee and the NLCA executive.
LCCOP Outliers Policy Document 2018 Click Here
LCCOP Outlier Response & Action Plan 2018 Click Here
Background: The SCTS Returns
The SCTS has collected activity and in-hospital mortality data in thoracic surgery for over 30 years. It is one of the largest and longest running datasets in thoracic surgery worldwide.
This project runs entirely through the goodwill of our members, who collect and report their own data. Their commitment to transparency and quality improvement over three decades has been a major strength of the Society’s work in thoracic surgery.
National Lung Cancer Audit 2016
Details and explanations of the lung cancer consultant outcomes publication (for the 2014 audit period) are available here. The results are available as a downloadable PDF:
The lung cancer consultant outcomes publication (for the 2013 audit period) is available here:
3 year Thoracic data summary
The SCTS released a summary of three years of activity from the SCTS thoracic registry. The report covers the 2011-2014 audit years and is available here:
SCTS 2014-15 Thoracic Registry Data
The SCTS thoracic registry data for the 2014-15 audit year is available for download here.
Data has been received from 36 hospitals in the UK and Ireland. This includes all active NHS thoracic surgery units that the Society is aware of in Scotland, England, Northern Ireland and Wales.
This year the Spire Hospital in Cambridge became the first independent hospital to submit data to the registry.
We have recorded a further increase in lung cancer resection to 7228 cases from 6713 last year, an increase of 7.7%.
98.1% of patients undergoing a lung resection for lung cancer survived to hospital discharge.
In total, 26,654 cases were reported, very close to the 26,746 reported in the previous year.
A further significant increase has been recorded in minimal access lung cancer surgery. 2131 VATS lobectomies for lung cancer were reported, representing 40% of all lobectomies for lung cancer. In contrast, 30% of lung cancer lobectomies were performed by VATS in 2013-14.
Open pneumonectomy (350 cases from 392) and mediastinoscopy/mediastinotomy (1854 from 2049) both registered reductions in activity.
Provisional SCTS 2013-2014 thoracic returns
VATS lobectomy rate now at 30%.
The provisional 2013-14 SCTS returns for thoracic surgery are available here. We have received data from 3 Scottish units, 28 English, 2 Welsh, 1 Northern Irish and 1 in the Republic of Ireland. 1 English and 4 Republic of Ireland units that have previously submitted data have not yet done so for this audit year.
An initial analysis shows that the proportion of lobectomies for lung cancer performed by a minimal access (“keyhole”) approach has increased. 30% of these operations were performed by VATS, an increase from 23% in 2012-13. This is the highest rate of minimal access lobectomy that we have ever recorded.
The in-hospital mortality rate for common lung cancer operations has remained broadly static. Pneumonectomy is at 5.9% from 5.0%, open lobectomy is unchanged at 2.0% and thoracoscopic lobectomy mortality is down slightly at 0.7% from 1.0%. Thoracoscopic sublobar resections for lung cancer carried a mortality risk of 0.18%.
The overall in-hospital mortality risk for lung cancer resection (all procedures) was 1.7%.
We will update these data as further results are reported to us.
2012-2013 Thoracic Returns Now Available
Nearly a quarter of lobectomy procedures for cancer now performed by VATS. Overall activity and mortality broadly static.
Completeness of the Registry
The SCTS thoracic returns for 2012-13 are available here. Data was received from one Northern Irish, three Scottish, two Welsh, two Republic of Ireland and 29 English hospitals.
We believe that all NHS hospitals in Scotland, England, Northern Ireland and Wales undertaking thoracic surgery have submitted data. Three units in the Republic of Ireland, which have previously submitted data, have not submitted data in this audit period.
Overall and Primary Lung Cancer Activity
27,267 operations were reported to the Society, from 27,218 in 2011-12. This included 6474 resections for primary lung cancer. This represents a 1.8% increase in activity compared with 2011-12, and slower rate of growth than in recent years.
The fall in mediastinoscopy and mediastinotomy procedures that we have reported in previous years continued, with 2328 procedures, a further 5.6% drop from 2011-12. The wider availability of EBUS and the routine use of staging PET-CT may be responsible for this long-term trend.
Minimal access lung resection continues to increase, with a 42% increase in the number of VATS lobectomies performed to 1047 cases. 23% of all lobectomies for cancer were performed thoracoscopically, the highest level that we have ever recorded. As a corollary to this, here were slight falls in all forms of open surgery for lung cancer. Pneumonectomy now accounts for only 6% of lung resections for primary cancer.
Activity Changes: Non-Lung Cancer
We recorded a significant fall in surgery for chest wall deformity, with only 211 open cases reported, a fall of 32% year-on-year. Minimal access pectus surgery also fell marginally from 68 to 64 cases. This may reflect more stringent funding criteria for these procedures.
Another area where we saw reduced case volumes was oesophageal surgery, with 270 open and no thoracoscopic resections for oesophageal cancer reported, relative declines of 19.4% and 100% respectively compared with 2011-12.
Open mesothelioma surgery saw an increase in non-radical pleurectomy/decortication, up from 56 to 85 cases, but a fall of 50% in VATS pleurectomy to 102 cases. Radical mesothelioma surgery remained static at 66 cases, including 2 extrapleural pneumonectomies.
In Hospital Mortality
In hospital mortality after open lobectomy for lung cancer remained static at 2%, and VATS lobectomy at 1%. Only 116 open/close thoracotomies were reported, 2.3% of all open surgery for lung cancer. Overall in-patient mortality across the entire registry was 1.4%.
You can download the 2012-13 data here.
Download previous SCTS data or reports or copies of the register data 2000-12 here.
NATIONAL ACTIVITY & OUTCOMES REPORTS (THE BLUE BOOKS)
National Activity and Outcomes Reports for 2008 and 2011 are available here:
SCTS and the Lung Cancer Consultant Outcomes Publication in England
In 2014 the Healthcare Quality Improvement Partnership asked the National Lung Cancer Audit and the SCTS to produce outcomes data on operations for primary lung cancer in England. This is part of a project across surgical specialties within England, known as the Consultant Outcomes Publication.
The lung cancer data is available on SCTS.org or on the NHS England site. In 2014, unit 30 and 90 day mortality, together with resection rates by MDT and individual surgeon activity data was published.
The plan for 2015 is to use the same outcomes reporting method.
SCTS has welcomed this initiative, as we believe that transparent reporting of accurate, useful data will improve standards of care for our patients. We are working with the NLCA, HQIP and patient groups to develop the COP project, so that it reports usable, appropriate data that accurately reflects quality of care.
I would greatly welcome input from audit leads, surgeons, data managers, patient representatives and other stakeholders as we develop the Society’s thoracic audit systems and published output. You are welcome to contact me directly at email@example.com.
Thoracic Audit Lead