Canadian healthcare systems have led countless initiatives to improve the quality and efficiency of patient care; yet no reliable mechanism exists to share patient information between disease sites due to a lack of data standardization, and consequently, no complementary system to communicate policy needs to decision makers. This lack of information flow directly impacts the quality and efficiency of surgical care, as comparison of surgeon outcomes is impossible, making it difficult to identify best practices. Given the overwhelming impact of AEOs on patient experience and healthcare spending, and their association with surgical technique and preventability, it is imperative that surgeons become aware of their AEOs in comparison to other surgeons and institutions, and that we invest in CTs evaluating surgical techniques and their impact on AEOs.

In that respect, the proposed Canadian Association of Thoracic Surgeons Quality Improvement Program (CATSQIP) is a continuous benchmarking initiative intended to identify best practices in surgical care and to generate opportunities for observational and interventional research in the thoracic surgery population. Benchmarking is made possible by standardizing data collection across sites, allowing surgeons and institutions to be benchmarked against the mean scores of their peers, with trends tracked over time both within and between participants. Benchmarking will both identify best practices, and encourage surgeon uptake of these practices. The collection of clinical data including AEOs occurs at the local institutional level with multicentered collated data in a formal reporting mechanism. The information collected in this formal reporting mechanism is not only used for benchmarking purposes but also to inform other innovative QI processes in the CATSQIP in the form of M&M rounds and PD seminars. Thus, data becomes actionable by feeding it to locally-implemented M&M rounds, and inter- and intra-institutional PD seminars that similarly serve to improve the efficiency and quality of patient care. Of equal importance is the potential of this research platform to generate future research afforded by this initiative. Considering the paucity of surgical research in the literature and the obstacles associated with RCTs in surgery, such a platform would present a significant resource for evaluating surgical techniques and their impact of AEOs, as well as research in surgical outcomes in general. To demonstrate the research potential of this reporting mechanism, three multicenter CTs assessing surgical techniques will be conducted within this initiative.