The European Thoracic Database project: composite performance score to measure quality of care after major lung resection

Background: Performance measurement is an essential element of quality improvement initiatives. The objective of this study was to develop a composite performance score (CPS) incorporating processes and outcomes measures available in the European Society of Thoracic Surgeons (ESTS) Database and apply it to stratify performance of participating units. Methods: A total of 1656 major lung resections for malignant primary neoplastic disease were collected in the ESTS database from 2001 through 2003 and were analyzed. For the purpose of this study only data collected from units contributing more than 50 consecutive cases were included. Three quality domains were selected: preoperative care, operative care, and postoperative outcome. According to best available evidence the following measures were selected for each domain: preoperative care (% of predicted postoperative carbon monoxide lung diffusion capacity (ppoDLCO) measurement in patients with predicted postoperative forced expiratory volume in one second (ppoFEV1)