For a study, researchers wanted to determine the parameters utilized by the Society of Thoracic Surgeons (STS) to rank lobectomy and demonstrate to enhance their approach. The purpose was to study lobectomy STS data and the results using root cause analysis and lean techniques to improve the outcomes. 30-day mortality, pneumonia, adult respiratory distress syndrome, bronchopleural fistula, pulmonary embolus, initial ventilator support of more than 48 hours, reintubation and respiratory failure, tracheostomy, myocardial infarction, or unexpected return to the operating room are the STS metrics. 

Over three years, from July 2011 to June 2014, 16 of 231 programs (7%) received a 3-star rating. Failure to escalate care was the most common root cause analysis. Increased exercise before surgery, adding a respiratory therapist, eliminating Foley catheters and arterial lines to reduce infection and increase ambulation, offering stereotactic radiotherapy for marginal patients, favoring left upper segmentectomy over left upper lobectomy, and performing 91% of the last 493 lobectomies via a minimally invasive platform was among the lean and process improvements they implemented that seemed to improve the results.

From August 2003 to December 2014, the significant morbidity complications decreased from 9.5% to 5.3% (P=0.001), and death declined from 3.3% to 0.54% (P<0.0001). The STS utilized 30-day mortality and, in particular, respiratory problems to rank lobectomy regimens. Over three years, they improved the lobectomy patient outcomes through root cause analysis, lean methodology, and process improvements, resulting in a 3-star rating. Others may be able to replicate these results.