Thoracic Surgery Update 2016

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Presentation transcript:

Thoracic Surgery Update 2016 Doug West

Mortality benchmarking and LCCOP Activity trends in Bristol Summary Resection rates Mortality benchmarking and LCCOP Activity trends in Bristol Activity: national benchmarks In patient data: ERAS and statistical process control Initiatives EBUS Video POAC Trials and research

Resection Rates

Regional resection rates 2009-15

2014/5 resection rates: South West Regional Picture NBT 22.6% Weston 22% Taunton 20.6% Bath 18.8% C+G 18.6% Yeovil 17.8% UHB 11.8% Oxford 28.2% Southampton 23.1% H of E 15.1%

Mortality at 30 and 90 days

Results at 30 days

Results at 90 days

90 day survival

Activity 2011-12 to 2014-15

Primary lung cancer activity 2011-12 to 2014-15

Benchmarking: SCTS data

Inpatient ERAS and SPC data

Invasive mediastinal staging at UHB

EBUS project Scope and stack already purchased New procedures consent gained Fits with other interventional treatments stenting / debridement EBV / coiling Anaesthetic support Likely volumes 40-50 / year initial

Video POAC Why? Reduces travel time Where? North Bristol Speeds listing for surgery Where? North Bristol 1st case now in Gloucester Peripheral referrers may benefit most

Capacity and critical care beds Major issue over winter Extra capacity overnight recovery recently opened Six day operating March-April Challenges Capacity loss to other specialties In patient transfers

Trials activity PuLMiCC RCT and registry: surgical resection vs. medica therapy in colorectal lung metastases VIOLET NIHR RCT: VATS vs. open lobectomy for lung cancer lobectomy PneumRx registry Endobronchial coils for severe emphysema LIBERATE Commercial RCT: Endobronchial valves for severe emphysema SuMiPort Pilot RCT single vs. mulitple ports for lung wedge resection Recently Closed ErLaPara, ProVIOLET

Particular thanks too… Fast referral form Gianluca Casali Video POAC Ali Johnstone and Eveline Internullo (UHB), Sarah Smith and Debs Walton (NBT), Heather Youd and Sid Roger (GRH) CNS-led follow up after lung cancer surgery Caroline Carman, Lois Philips EBUS pilot group Eveline Internullo, Doug West, Rakesh Krishnadas SCTS Thoracic Medalists Natasha Joshi, Kaj Kamalanathan