ANZTHOR Registry: A Model for Specialty Surgical Quality Assurance in Australia
Principal investigators
Associate Professor Phillip Antippa OAM, Head of Thoracic Surgery, The Royal Melbourne Hospital
Associate Professor Gavin Wright, Director of Surgical Oncology, St Vincent’s Hospital Melbourne
ANZTHOR Registry: A Model for Specialty Surgical Quality Assurance in Australia.
The Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) has achieved a significant milestone in surgical quality assurance with the successful establishment of the Australian and Aotearoa New Zealand Thoracic Clinical Quality Registry (ANZTHOR).
ANZTHOR is the only clinical quality registry for thoracic surgery across Australia and Aotearoa New Zealand and is, with the support of BioGrid, transforming thoracic surgery data collection and quality monitoring across the region. The registry addresses what was a critical gap for Thoracic Surgeons - the lack of comprehensive data about outcomes.
When looking for a partner to provide registry services for Thoracic Surgeons, the Society supported the surgeons’ preference for a partner who prioritises data custodian requirements, provides data security and privacy as standard practice, and supports clinicians every step of the way, from determining data elements and structure through to quality assurance auditing and performance reporting.
Breaking new ground in thoracic surgery data
While cardiac surgery has long benefited from a robust 22-year-old registry, Thoracic Surgeons lacked comprehensive data collection systems to record and report their outcomes. The ANZTHOR registry, established in late 2021, provides Thoracic Surgeons with a robust platform for quality assurance and performance monitoring.
Despite major improvements over the years in thoracic surgery, before ANZTHOR there was no tracking of the results of thoracic surgery and no mechanism for reviewing the work volumes. This meant it was impossible to get a clear view of whether there was a variation of care across providers in both Australia and Aotearoa New Zealand.
“It's very hard to put your finger on what thoracic surgery is in this country. We want that picture and we also want to ensure there's at least a minimum quality of surgery across the board,” says Associate Professor Gavin Wright, Director of Surgical Oncology at St Vincent’s Hospital in Melbourne, Lung Cancer Research and Education Lead, VCCC Alliance and Chair, Cancer Australia Lung Cancer Advisory Group.
“That’s the number one priority for ANZTHOR – getting a view of how the field is performing across the country.”
The dataset enables the ANZTHOR Steering Committee to record and analyse unique key quality indicators (KQIs) for thoracic surgery. These indicators will be used to examine specific variations in care against best practice or clinical guidelines to ensure care is appropriate and to map outcomes focused on the effectiveness of thoracic surgery.
In addition, the KQIs will be linked to the National Death Index (NDI) to provide survivorship data, through BioGrid’s partnership with the Australian Institute of Health and Welfare (AIHW).
Linking the ANZTHOR quality registry with the National Death Index will help Thoracic Surgeons accurately assess long-term survival outcomes and the impact of surgical quality for patients undergoing thoracic surgery, especially after lung cancer screening.
Key aims of ANZTHOR
The ANZTHOR program collects data about thoracic surgery with the objective of improving oversight and outcomes. The stated aims of the program are:
- Monitoring the volume and distribution of thoracic surgery across Australia and Aotearoa New Zealand
- Report on key performance indicators to assist in thoracic surgery benchmarking
- Identify variation in practice
- Support peer review of care quality
- Facilitate clinician/institutional quality audit
- Maintain robust data to facilitate research
BioGrid’s expertise provided a comprehensive solution
BioGrid was selected to deliver a solution that achieved the key aims of the ANZTHOR program, in particular the ability for sites contributing data to retain access to their own data set for clinician and institutional quality audits.
BioGrid provided comprehensive support across the whole data lifecycle, including providing guidance through the complexities of ethics and governance across multiple sites, and helping ensure full compliance with regulatory standards.
BioGrid’s ethics and governance expertise was key
BioGrid’s expertise in ethics and governance were major factors in their engagement. While the REDCap database is the core of the data solution, the way the data is collected and managed is key to the success of the program.
BioGrid managed the establishment of the ethics and governance for the program, ensuring that the registry protocol and database development fulfilled the requirements for a clinical quality registry.
This has resulted in ANZTHOR being registered with the Australian Commission on Safety and Quality in Health Care (ACSQHC). BioGrid continues to manage ethics and governance for the ongoing program requirements, as well as coordinating the program’s steering committee.
BioGrid onboards new sites as they join the program, ensuring ethics and governance is in place for each site to participate in the registry, providing training on accessing and using the registry, and helping them set up technical requirements, if required.
BioGrid also provides regular reporting against the key performance indicators to each of the participating sites and to the ANZSCTS.
Getting the unique technical requirements right
ANZSCTS’s approach to the ANZTHOR registry incorporated several key innovations that address real-world surgical challenges. The system features approximately 80 mandatory fields complemented by optional modules, allowing for both standardised data collection and specialty-specific customisation.
BioGrid advised on the design of the modular architecture, ensuring that the subsequent implementation by BioGrid would position the registry to evolve with changing clinical needs and research priorities.
BioGrid also developed dynamic reporting tools using SAS Visual Analytics that have improved how thoracic surgery departments conduct their monthly audits. Instead of registrars spending hours collating data and preparing slides, surgical teams can now access real-time audit reports simply by selecting date ranges. This efficiency gain represents a tangible improvement in workflow that directly benefits busy clinical teams.
A voluntary model that works
ANZTHOR is open to all surgeons practising thoracic surgery regardless of their primary specialty or practice location. This inclusive approach recognises that thoracic surgery is performed not only by subspecialist cardiothoracic surgeons but also by general surgeons in rural areas who provide essential services to their communities.
The registry's accessibility has been enhanced by the decision to make participation free for contributing hospitals - a significant advantage over fee-based alternatives. This cost-neutral approach removes financial barriers that might otherwise limit participation, particularly for smaller or regional centres.
Quality beyond complications
One of the most innovative features of ANZTHOR is its comprehensive approach to quality measurement, incorporating key performance indicators specifically designed for thoracic oncology.
These process-based quality indicators examine whether best practices are being followed rather than simply measuring outcomes. Questions include whether pulmonary function tests were performed, whether PET scans were conducted appropriately, whether tissue diagnosis was obtained before resection, and whether patients were discussed in multidisciplinary meetings. This approach provides a more nuanced understanding of care quality and helps identify opportunities for improvement before they manifest as adverse outcomes.
Timeliness is an important part of surgical auditing and ANZTHOR will utilise live data reporting via SAS, which is provided as part of BioGrid’s service.
Thoracic surgery units will also receive reports on the condition of their data sets after the annual automated data cleaning process, enabling the units to make any required changes to the source data in the registry and to improve data collection processes to ensure the data is captured according to ANZTHOR’s data requirements.
AIHW NDI data linkage enables survivorship analysis
A critical element of enabling quality measurement is linking ANZTHOR to the Australian Institute of Health and Welfare’s (AIHW) National Death Index (NDI).
“The ability to link NDI mortality data enables robust measurement of survival outcomes, causes of death, and performance benchmarking related to mortality across different conditions, treatments, hospitals, and geographic areas,” says Associate Professor Antippa.
“This evidence is essential for evaluating and improving the safety, quality, and effectiveness of health care delivery at both the hospital and population level.”
“The ability to link NDI mortality data enables robust measurement of survival outcomes, causes of death, and performance benchmarking related to mortality across different conditions, treatments, hospitals, and geographic areas”.
Professor Antippa
Unique Oncological Key Quality Indicators (KQIs)
- Pulmonary function tests (spirometry and diffusing capacity) performed prior to any surgical resection of lung
- Mediastinal staging with either PET scan, mediastinoscopy or EBUS with representative biopsy
- Tissue diagnosis prior to resection (this can include on table wedge frozen section)
- Where a diagnosis of cancer is made case discussed at a Multidisciplinary Team Meeting
- Anatomical resection for any lesion greater than 2cm
- Lymph nodes taken from at least 3 stations
- Complete resection (R0)
- Referral for Guideline based systemic therapy (neoadjuvant or adjuvant)
Other than oncological key quality indicators (KQIs), the database captures a broad range of complications and includes those that are common as well as those that are significant but uncommon.
These include: death (from any cause), general complications (pulmonary, cardiovascular, neurological or infective) of which more details will be obtained, operative complications (returns to theatre, unplanned admission to the intensive care unit or HDU, stroke, pneumonia or respiratory failure) and those complications that are specific to thoracic surgery (discharge with a chest drain, discharge on home oxygen).
Impressive early results
In just a few years of operation, ANZTHOR has collected data on almost 3,500 cases across public and private hospitals. The registry's ethics framework was designed to permit both prospective and retrospective data collection, allowing participating centres to include historical cases where appropriate data existed. This flexibility has accelerated the registry's growth and enhanced its analytical power.
The system successfully captures the full spectrum of thoracic surgical procedures, with lung resections representing the majority of cases alongside pleural procedures. The ability to analyse cancer cases by tumour type provides valuable insights into case mix and outcomes across different pathologies.
A template for specialty registries
ANZTHOR's success illustrates the value of BioGrid’s collaborative approach to registry development. By working closely with surgical specialists to develop a deep understanding of their unique requirements, BioGrid has created a registry that serves immediate clinical needs while building capacity for future research and quality improvement initiatives.
The registry demonstrates how specialty surgical databases can move beyond simple data collection to become integral tools for clinical governance, professional development, and healthcare system accountability. As Australia's healthcare system increasingly emphasises value-based care and outcome transparency, registries like ANZTHOR provide the evidence base necessary for informed decision-making.
Supporting national initiatives to improve thoracic health in the community
By the time the Australian Government announced the introduction of the Australian National Lung Cancer Screening Program (NLSCP), which started operating in July 2025, ANZTHOR had been operating for several years.
The NLCSP is a screening program using low-dose computed tomography (low-dose CT) scans to look for lung cancer in high-risk people without any symptoms, with the objective of finding lung cancer early and saving lives.
“We encouraged hospitals to come on board before the screening program started, because we believe ANZTHOR will be very helpful in ensuring transparency in terms of best practice,” says Associate Professor Wright. “We really want to make sure these patients, who are asymptomatic with a curable cancer, experience minimum harms and maximum cure rates.”
Providing valuable data for analysing surgical performance
For medical researchers, ANZTHOR represents a valuable, flexible resource for understanding thoracic surgery outcomes and identifying opportunities for improvement. The registry's comprehensive dataset, combined with its sophisticated analytical capabilities, positions it as a platform for addressing important clinical questions about surgical techniques, patient selection, and care pathways.
The collaboration between ANZSCTS and BioGrid Australia in developing ANZTHOR provides a compelling model for other medical specialties seeking to establish clinical quality registries. It demonstrates that with appropriate technical expertise, clinical engagement, and strategic vision, it's possible to create secure, ethically approved data collection systems that enhance rather than burden clinical practice while advancing the specialty's scientific foundation.
Supporting the next generation
Along with supporting immediate clinical quality improvements, ANZTHOR also addresses training and education needs by providing linked logbook data for surgical trainees.
This integration with training requirements reduces administrative burden for trainees while ensuring accurate documentation of their surgical experience.
The system demonstrates how well-designed registries can serve multiple stakeholders simultaneously.