Focus on specific disease-part 2: the European Society of Thoracic Surgery chest wall database

Introduction

Data collection has gained a great importance in numerous areas in the last years and also in the medical field. Collecting data is the key to knowledge and consequently improving data quality is fundamental, as the results of the data analysis can have a large impact on the clinical practice (1,2). Collected data can be employed to assess the performance of surgeons or institutions and to implement hospital’s performance and productivity.

The European Society of Thoracic Surgery (ESTS) database is a multi-institutional and international registry, where the data are collected using a protected online platform (https://ests.kdataclinical.it) (3). To date, up to 15,000 new cases are registered in the database annually from 24 different countries, in details from 170 European and 15 non-European thoracic surgery units (4).

The chest wall database is one of the satellites composing the ESTS database and it collects data about the whole spectrum of chest wall diseases, like tumors, traumas or malformations (Table 1).

Table 1 Spectrum of diseases managed in the ESTS chest wall database
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Methods

Aim and characteristics of the chest wall database

The ESTS chest wall database includes data on risk factors, surgical techniques, processes of care and outcomes related to chest wall pathologies. These data are designed for quality control and performance audit. The registry comprehends the whole spectrum of the chest wall diseases in the form of a detailed database with the aim to find out the best practice at European (and non-European) level in order to develop guidelines and establish a standard to improve the outcome. A composite performance score (CPS) was created to assess the outcomes in different aspects of surgical practice of the participating thoracic surgery units (5,6). Monitoring of implants durability, possible complications and bad reactions in patients undergoing correction of chest wall deformities are highlights for the data collection and open some research possibilities. Data on patients’ surveillance after a chest wall procedure are also collected in the registry.

In the last 20 years, chest wall surgery has undergone a considerable growth in technique and material used for reconstruction (7). In fact, many techniques and materials are currently used from different thoracic surgeons in different areas, as so far there are no guidelines for the management of this kind of diseases. The chest wall database is determined to fulfill this purpose.

Another main objective of the database is to endorse the cooperation between international societies. The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD) and the ESTS Registry Task Force already have a cooperation since 2012 (8). The two societies database task forces meet annually to plan future research projects. In the last years were published some studies from the joint cooperation of the two registries (4), after the data harmonization and standardization between the databases.

Participation

The participation to the registry is free and voluntary for the ESTS members. At least one staff member should retain an ESTS membership and the participants have to request and obtain a personal login account completing the specific application form, which can be downloaded from the ESTS homepage (http://www.ests.org/collaboration/database_registration_form.aspx).

Every single contributor/unit has several benefits besides the obvious advantages for the medical community. In fact, every thoracic surgery unit participating to the database can access its own data collected in a standardized ESTS-endorsed dataset, which can be downloaded and used for internal analysis, statistics or research. Furthermore, the participants will receive a feedback regarding the quality of their data and performance compared to the international benchmarks. Every participating thoracic surgery unit can access the ESTS certification program (http://www.ests.org/collaboration/ests_quality_certification_programme.aspx) and can submit a research project to the ESTS database task force to access data derived from the entire database (http://www.ests.org/collaboration/ests_database_rules_for_publications_and_presentations.aspx).

Data collection

Acquired data are anonymous, independently accessed and encrypted on a Dendrite platform, which provides data security and regular backups. The registry is managed by an external company (KData Clinicak Srl), which works together with the Database Committee in revising and updating periodically the database. Single institutions and national registries can upload data in the database (9,10). Every year the ESTS Registry Annual Report (Silver Book) is published on the ESTS homepage (http://www.ests.org/collaboration/database_reports.aspx) including all data collected during the year (Figure 1).

Figure 1 Data collected in the chest wall database (source from the Silver Book 2016).

Results

The ESTS chest wall database is structured in four main sections: preoperative, intraoperative, postoperative and follow up. For each procedure registered in the database are collected a number of different variables regarding the patients’ characteristics, the surgical technique, the postoperative course until the discharge and also follow up data (Tables 2,3). Figure 2 shows the number of collected procedures for chest wall deformities until November 2017. In 2016, 2,534 procedures in total were registered in the database according to the silver book and the vast majority of these procedures consisted of surgery for correction of chest wall deformities. Correction of pectus excavatum is the most common procedures registered in 2017 (392 patients, 67% of all data), followed by pectus bar removal (159 patients, 27% of all procedures). Figure 3 shows the correlation between age and gender. Males are generally more affected than females and most patients undergo the procedure in a young age (<40). Figure 4 shows the data regarding the materials used for reconstruction in patients undergoing surgery for pectus excavatum. Figure 5 describes the completeness of the collected data. The data have been collected from 32 hospitals from many European and non-European countries, in particular Brazil. In the supplementary is described in details the core dataset of the chest wall database in all its sections.

Table 2 Structure of the ESTS chest wall database
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Table 3 Intraoperative characteristics in details
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Figure 2 Total number of chest wall procedures registered in 2017 (updated until 11/2017).

Figure 3 Chest wall procedures related to gender and age (updated until 11/2017).

Figure 4 Data about material used to reconstruction in patients undergoing pectus excavatum.

Figure 5 Completeness of the collected data.

Conclusions

The ESTS chest wall database is an ambitious European project, which aims to standardize all chest wall procedures in all their aspects, starting from the preoperative preparation, continuing with the surgical technique and helping treating complications. It has the potential to increase the number of collected data within the next years, taking account of the fact that currently only 15% of the European thoracic surgery units are contributing to the registry. Each thoracic surgery department should understand the advantages that imply joining the database, as single unit and as part of the whole group to improve the thoracic surgery practice around Europe.

ESTS preoperative chest wall
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ESTS operative chest wall
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ESTS postoperative chest wall
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ESTS follow up chest wall
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Acknowledgements

None.

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

References

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