Benchmarking in thoracic surgery

Freixinet, J.; Varela, Gonzálo; Molins, Laureano; Rivas, Juán J.; Rodríguez-Paniagua, José Manuel; Castro, Pedro López de; Izquierdo, José Miguel; Torres, Juan Pablo

doi:10.1016/j.ejcts.2010.10.010

Cited by 24 publications

(17 citation statements)

References 11 publications

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“…Reported mortality rates range from 0.2% to 3.1%. However, variability in the percentage of pneumonectomies or extended surgical procedures performed has been witnessed among different centres complicating a cross-study comparison (15)(16)(17)(18).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of major video-assisted thoracoscopic surgery on care quality

Valenzuela¹,

Fernández²,

Cirre³

et al. 2017

J. Thorac. Dis.

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Section: Discussionmentioning

confidence: 99%

“…Other studies (19,20) included atypical VATS segmentectomies and resections, with an overall readmission rate of 8-9%. Of note, the studies performed within the framework of the benchmarking study conducted in Spain from 2011 to 2015 documented readmission rates of 2.6-7.3% and 0-6.4% respectively (15,18).…”

Section: Discussionmentioning

confidence: 99%

Impact of major video-assisted thoracoscopic surgery on care quality

Valenzuela¹,

Fernández²,

Cirre³

et al. 2017

J. Thorac. Dis.

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“…If the lesion is benign and only a wedge resection is needed, the operative mortality is usually only 0.5%. [73][74][75][76] However, if lobectomy is required, the mortality will be between 1 and 4%. [73][74][75][76] More central lesions may make wedge resections impractical, and patients harboring very central nodules may require lobectomy even for benign lesions.…”

Section: Surgerymentioning

confidence: 99%

The Solitary Pulmonary Nodule—Deciding When to Act?

Lazarus

Ost

2013

Semin Respir Crit Care Med

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Solitary pulmonary nodules (SPNs) are commonly encountered in pulmonary practice. Their management is complex, and multiple clinical factors must be considered. The three common management strategies applied to solitary pulmonary nodules are careful observation, diagnostic testing, and surgery. Fundamental concepts derived from decision analysis can be used to help clinicians choose optimal management strategies for individual patients with SPNs. This process begins with estimating the pretest probability of cancer. Then the consequences of treatment are considered-including the benefit of surgery if the patient has cancer and the harm of treatment if the patient does not have cancer. Patient comorbidities and competing risks affect the consequences of treatment. Knowledge of the benefits and harms of treatment allows clinicians to determine the treatment threshold and then rationally develop the optimal management plan. Probability revision using the pretest probability, test characteristics, and Bayes theorem is used to refine the probability of cancer until a decision threshold is reached and definitive treatment can be determined. Patients with very low pretest probability of cancer are managed with a strategy of careful observation by serial computed tomography (CT). Patients who have a high pretest probability of cancer merit surgical diagnosis. Patients with an intermediate pretest probability of cancer go on to further diagnostic testing, primarily with CT-guided fine needle aspiration or positron-emission tomography. Patient preferences are considered throughout the process because the absolute difference in outcome between some strategies may be small.

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“…Studies using traditional techniques, such as conventional fluoroscopic guidance, demonstrated diagnostic yields of 10% -50% overall and approximately 33% for peripheral lesions less than 20 mm in diameter [41].…”

Section: ) Careful Observationmentioning

confidence: 99%

“…If the nodule is found to be benign at frozen section, then only a wedge resection is required, and operative mortality is typically low (≈0.5%) [9] [41] [42] if the nodule is found to be malignant, then a lobectomy with systematic lymph node dissection is preferred. Lobectomy mortality has been reported to be 1% -4% [41] [42].…”

Section: ) Careful Observationmentioning

confidence: 99%

Differentiation of Benign and Malignant Solitary Pulmonary Nodule: Literature Review

Tripathi¹,

Zhen²

2015

ALC

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The solitary pulmonary nodule (SPN) is frequently seen on chest radiographs and computed tomography (CT), usually the identification is accidental. The overall prevalence of malignancy is relatively low but identification of malignancy of nodule is of prime importance. There are different characters of nodules indicating malignancy, and also the exposure of person to risk factors increases the chances of malignancy of nodule. Chances of malignancy rise with increasing size, the irregular, lobulated border of the nodules is highly associated with higher probability of malignancy and nodules with pure ground grass appearance have higher probability of malignancy, irregularly marginated nodule displaying a corona radiata sign indicating neoplastic infiltration with distortion of neighbouring tissue is almost certainly a malignant nodule. Stippled, punctuate, and eccentric calcifications are suggestive of malignancy. There are 20% -75% of chances of malignancy if nodule is appeared with ground-glass opacity. Malignant nodules have higher growth rate as compared with benign nodules, malignant nodules usually have doubling time (DT) of 30 -400 days while DT of more than 450 days is sign of benignity whereas doubling time less than 30 days is usually acute infectious process. The presence of fat within nodule is sign of benignity. Increasing density of the nodule is suggestive of malignancy and requires shorter follow up. Besides the nodule evaluation the chances of malignancy can also be evaluated through the exposure of patient to risk factors like age, current and past smoking status and history of extra thoracic malignancy. The management depends upon various factors mainly three strategies are applied for management including careful observation of nodule, use of diagnostic techniques like CT FNA, PET, and broncoscopy and surgery.

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Benchmarking in thoracic surgery

Abstract: Benchmarking could be an effective method for improving clinical management. A considerable variability was detected in our study among the participating groups.

Cited by 24 publications

References 11 publications

Impact of major video-assisted thoracoscopic surgery on care quality

Impact of major video-assisted thoracoscopic surgery on care quality

The Solitary Pulmonary Nodule—Deciding When to Act?

Differentiation of Benign and Malignant Solitary Pulmonary Nodule: Literature Review

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