1. Thoracic Surgery Update 2016
Doug West

2. 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

3. Resection Rates

4. Regional resection rates 2009-15

6. 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%

7. Mortality at 30 and 90 days

8. Results at 30 days

9. Results at 90 days

10. 90 day survival

11. Activity to

12. Primary lung cancer activity 2011-12 to 2014-15

17. Benchmarking: SCTS data

21. Inpatient ERAS and SPC data

25. Invasive mediastinal staging at UHB

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

27. 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

28. 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

29. 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

30. 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