The Comparison of Performance Between Thoracic Surgical Units

Managed care systems demand an increased effort in quality monitoring through the use of reliable instruments of performance evaluation. Comparison between units requires the definition and selection of proper indicators of quality. Outcome indicators are widely used in our practice but they need to be risk adjusted to prevent misleading information and unethical risk-averse behaviors. Regression analyses are commonly used for developing risk models. Bootstrap analysis can formalize the development of model building, removing much of the human biases associated with regression analysis and introducing a concrete measure of reliability of the risk factors. Recently published examples of comparisons of performance between different thoracic surgery units are summarized with the intent to provide a methodological template for future comparative audit investigations.