Doug West, thoracic surgeon and SCTS audit lead, looks at the Lung Cancer Clinical Outcomes Publication (LCCOP) and how it has developed into a mandatory national audit.
As I write this, the analysis for the 2015 LCCOP data is being completed ready for publication in November. This audit has been commissioned by the Healthcare Quality Improvement Partnership (HQIP), and delivered by the National Lung Cancer Audit team in partnership with the Society for Cardiothoracic Surgery (SCTS). Its aim is to put validated outcomes data following lung cancer surgery in the public domain.
The results from LCCOP are available in a searchable format on NHS Choices, and also at the Society for Cardiothoracic Surgery in Great Britain and Ireland (SCTS), which allows visitors to search for data by region, by hospital or by individual surgeon. The full national report is available for download, and for real fanatics the methodology report and other background documents are available too.
The LCCOP aims to put validated outcomes data following lung cancer surgery in the public domain.
What outcomes are published?
In its first year, LCCOP published unadjusted 30- and 90-day mortality rates after lung resection, together with derived resection rates for individual units. The number of cases that a surgeon personally performs is published, alongside the results that their unit has achieved. Over the past few years, we have been able to extend upon these outputs. Last year, we were able to adjust for a number of risk factors, including performance status, disease stage, and comorbidity data from the Hospital Episode Statistics (HES) dataset.
This means that units which operate on higher-risk patients have some allowance made for this in their results. This isn’t perfect – for example, we can only adjust for co-morbidities that are pre-recorded in the HES dataset – but it is a start. We added length-of-stay data, and survival rates at 1 year post-surgery last year. We also look at survival rates by procedure, documenting the relationship between the procedure performed and the perioperative risk.
LCCOP is now established, and developing in both scope and sophistication.
Expansion of the outcomes that we report raises some important questions for the future. Can we really hold units to account for their 1-year outcomes, when many other factors beyond the surgical teams’ control, oncological or local supportive care for example, contribute? Should we be reporting more process of care outcomes, as the main National Lung Cancer Audit does?
To be robust, process outcomes – for example, lymph node dissection rates – would need to be reported in systematic and uniform ways. When we consider adding new outcome measures, we should be asking two important questions: is the new outcome evidence based, and do we have evidence that it matters to patients and their families? Focusing on what patients want to know, rather than what is easy to measure, is essential.
LCCOP is now established, and developing in both scope and sophistication. Much remains to be done, but we should be proud that we now have a national mandatory audit, with results easily available to patients, the public, and those funding and delivering surgical care. The results achieved compare well with international data, and results across England are surprisingly consistent. This transparency can only help to improve and develop surgery for future patients.
Doug West, Society for Cardiothoracic Surgery thoracic Audit lead and thoracic surgeon, University Hospitals Bristol NHS Foundation Trust
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