The Society of Thoracic Surgeons National Database 2016 ...

OUTCOMES ANALYSIS, QUALITY IMPROVEMENT, AND PATIENT SAFETY

The Society of Thoracic Surgeons National

Database 2016 Annual Report

Jeffrey P. Jacobs, MD, David M. Shahian, MD, Richard L. Prager, MD, Fred H. Edwards, MD, Donna McDonald, RN, MPH, Jane M. Han, MSW, Richard S. D'Agostino, MD, Marshall L. Jacobs, MD, Benjamin D. Kozower, MD, Vinay Badhwar, MD, Vinod H. Thourani, MD, Henning A. Gaissert, MD, Felix G. Fernandez, MD, Cameron D. Wright, MD, Gaetano Paone, MD, Joseph C. Cleveland, Jr, MD, J. Matthew Brennan, MD, Rachel S. Dokholyan, MPH, Leo Brothers, MPH, Sreekanth Vemulapalli, MD, Robert H. Habib, PhD, Sean M. O'Brien, PhD, Eric D. Peterson, MD, MPH, Frederick L. Grover, MD, G. Alexander Patterson, MD, and Joseph E. Bavaria, MD

Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland (JPJ, MLJ); Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, Florida (JPJ, MLJ); Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (DMS, CDW, HAG); University of Michigan, Ann Arbor, Michigan (RLP); University of Florida College of Medicine, Jacksonville, Florida (FHE); The Society of Thoracic Surgeons, Chicago, Illinois (DM, JMH, RHH); Lahey Hospital and Medical Center, Burlington, Massachusetts (RSD); University of Virginia, Charlottesville, Virginia (BDK); Division of Cardiothoracic Surgery, West Virginia University, Morgantown, West Virginia (VB); Emory University, Atlanta, Georgia (VHT, FGF); Henry Ford Hospital, Detroit, Michigan (GP); University of Colorado, School of Medicine, Aurora, Colorado (JCC, FLG); Duke Clinical Research Institute, Duke University, Durham, North Carolina (JMB, RD, LB, SV, SMO, EDD); Washington University School of Medicine, St. Louis, Missouri (GAP); Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania (JEB)

The art and science of outcomes analysis, quality improvement, and patient safety continue to evolve, and cardiothoracic surgery leads many of these advances. The Society of Thoracic Surgeons (STS) National Database is one of the principal reasons for this leadership role, as it provides a platform for the generation of knowledge in all of these domains. Understanding these topics is a professional responsibility of all cardiothoracic surgeons. Therefore, beginning in January 2016, The Annals of Thoracic Surgery began publishing a monthly series of

scholarly articles on outcomes analysis, quality improvement, and patient safety. This article provides a summary of the status of the STS National Database as of October 2016 and summarizes the articles about the STS National Database that appeared in The Annals of Thoracic Surgery 2016 series, "Outcomes Analysis, Quality Improvement, and Patient Safety."

(Ann Thorac Surg 2016;102:1790?7) ? 2016 by The Society of Thoracic Surgeons

The art and science of outcomes analysis, quality improvement, and patient safety continue to evolve at an increasingly rapid pace, and cardiothoracic surgery leads many of these advances. The Society of Thoracic Surgeons (STS) National Database is one of the principal reasons for this leadership role, as it provides a platform for the generation of important new knowledge in all of these domains. To better care for patients and to be successful in today's rapidly evolving health care environment, understanding these topics is an essential professional responsibility of all cardiothoracic surgeons. Therefore, beginning in January 2016, The Annals of Thoracic Surgery began publishing a monthly series of

Address correspondence to Dr Jacobs, Johns Hopkins All Children's Heart Institute, Johns Hopkins All Children's Hospital and Florida Hospital for Children, 601 Fifth St S, Ste 607, St. Petersburg, FL 33701; email: jeffjacobs@jhmi.edu.

scholarly articles on outcomes analysis, quality improvement, and patient safety [1?12].

The STS National Database has three major component databases: the STS Adult Cardiac Surgery Database (ACSD), the STS Congenital Heart Surgery Database (CHSD), and the STS General Thoracic Surgery Database (GTSD). In 2016, six of the articles that appeared in The Annals of Thoracic Surgery 2016 series, "Outcomes Analysis, Quality Improvement, and Patient Safety" were derived from the STS National Database [2, 4, 6, 8, 10, 12]: three articles on outcomes and quality (one each from ACSD, CHSD, and GTSD) [2, 4, 6], and three articles on research (one each from ACSD, CHSD, and GTSD) [8, 10, 12]. These six articles alternated with five additional articles on topics related to patient safety [3, 5, 7, 9, 11]. The purpose of this final article in the 2016 series is to provide a summary of the status of the STS National Database as of October 2016 and to summarize the articles from this series that were derived from the STS National Database.

? 2016 by The Society of Thoracic Surgeons Published by Elsevier

0003-4975/$36.00

Ann Thorac Surg 2016;102:1790?7

QUALITY REPORT JACOBS ET AL 1791

STS NATIONAL DATABASE 2016 ANNUAL REPORT

The STS National Database--Outcomes and Quality

The STS National Database captures outcomes data from 90% to 95% of the adult cardiac surgery programs in the United States of America and more than 95% of the pediatric cardiac surgery programs in the United States of America. The penetration of the STS GTSD cannot be calculated because the number of general thoracic surgical programs in the United States of America (the denominator of penetration) is not known. (Figure 3 in the report by Jacobs and colleagues [1] provides graphs documenting the number of

participants [the numerator of penetration; Fig 3A] and surgeons [Fig 3B] in the STS GTSD.) Table 1 of this article provides information about the size and penetrance of the three major component databases of the STS National Database [13, 14].

A fundamental function of the STS National Database is to provide feedback reports to participants that allow individual programs to benchmark their outcomes to national aggregate data. Each quarter, participants in the STS ACSD receive detailed feedback reports of their practice characteristics, including demographics, risk factor profiles, operative data, and outcomes,

Table 1. The Society of Thoracic Surgeons (STS) National Database Participationa

Variable

STS Adult Cardiac Surgery Databasea

STS Congenital Heart Surgery

Databasea

STS Congenital Cardiac STS General Thoracic

Anesthesia Modulea,b

Surgery Databasea

Participantsc in USA, No. Hospitals,d No. Surgeons, No. Operations,e No. States, No. Estimated penetrance at the hospital level,f,g,h No.

Programs that voluntarily publicly report (as of October 1, 2016), %

1,090 1,117 2,916 6,041,804

50 >90%?95% of hospitals

that perform adult heart surgeryf

50.0

114 121 370 383,558 39 >95% of hospitals that perform pediatric heart surgeryg 57.6

52 62 464 (anesthesiologists) 84,890 29 49.6%g

Public reporting is not available

Total countries (including USA),i No.

Participants outside USA, No. Hospitalsd

Surgeons, No. Operations,e No.

Total participants Total hospitalsd

Total surgeons Total operationse

9

29 29 182 9,165 1,119 1,146 3,098 6,050,969

4

6 6 22 11,422 126 127 392 394,980

2

1 1 1 (anesthesiologist) 0 53 63 465 (anesthesiologists) 84,890

282 344 913 458,864 43

?h

Public reporting is not yet available. Voluntary public reporting with GTSD is planned for 2017. 3

2 2 8 233 284 346 921 459,097

a Data were updated on September 9, 2016, except for the public reporting numbers, which were updated on October 1, 2016. b The STS Congenital Cardiac Anesthesia Module was developed jointly by the STS and Congenital Cardiac Anesthesia Society. c An STS database participant is a "practice group of cardiothoracic surgeons" or, uncommonly, an individual cardiothoracic surgeon. In most instances, an STS database participant is a hospital cardiac or thoracic surgery program. d In most situations, 1 STS database participant is linked to 1 hospital; however, in some instances, 1 STS database participant is linked to more than 1 hospital or 1 hospital is linked to more than 1 STS database participant. Therefore, the number of STS database participants and the number of hospitals is slightly different. e Total number of operations in the STS ACSD refers to the total number of operations captured in the STS ACSD since its formation in 1989. The total number of operations in the STS CHSD and GTSD refers to the total number of operations in the CHSD and GTSD since these databases began storing data at Duke Clinical Research Institute (DCRI) in 1998. DCRI is the data warehouse and analytic center for ACSD, CHSD, and GTSD. f Center-level penetration (number of CMS sites with at least 1 matched STS participant divided by the total number of CMS CABG sites) increased from 45% in 2000 to 90% in 2012. In 2012, 973 of 1,081 CMS CABG sites (90%) were linked to an STS site. Patient-level penetration (number of CMS CABG hospitalizations done at STS sites divided by the total number of CMS CABG hospitalizations) increased from 51% in 2000 to 94% in 2012. In 2012, 71,634 of 76,072 CMS CABG hospitalizations (94%) occurred at an STS site. Completeness of case inclusion at STS sites (number of CMS CABG cases at STS sites linked to STS records divided by the total number of CMS CABG cases at STS sites) increased from 88% in 2000 to 98% in 2012. In 2012, 69,213 of 70,932 CMS CABG hospitalizations at STS sites (97%) were linked to an STS record [13]. g The 2015 STS Congenital Heart Surgery Practice and Manpower Survey estimates that 125 hospitals perform pediatric cardiac surgery in the United States and 8 hospitals perform pediatric cardiac surgery in Canada [14]. h The penetration of the STS GTSD cannot be calculated because the number of general thoracic surgical programs in the USA (the denominator of penetration) is not known. Fig 3 in Jacobs and colleagues [1] provides graphs documenting the number of participants (the numerator of penetration) and surgeons in the STS General Thoracic Surgery Database. i Countries participating in the STS ACSD are USA (50 states), Argentina, Australia, Brazil, Canada, Israel, Italy, Turkey, and United Arab Emirates. Countries participating in the STS CHSD are USA (39 states), Canada (3 Canadian Provinces), Israel, and Turkey. Countries participating in the STS GTSD are USA (43 states), Singapore, and United Arab Emirates.

ACSD ? Adult Cardiac Surgery Database; CABG ? coronary artery bypass grafting; CHSD ? Congenital Heart Surgery Database; Centers for Medicare and Medicaid Services; GTSD ? General Thoracic Surgery Database; STS ? Society of Thoracic Surgeons; United States of America.

CMS ? USA ?

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STS NATIONAL DATABASE 2016 ANNUAL REPORT

Ann Thorac Surg 2016;102:1790?7

Table 2. Selected Outcomes of the More Commonly Performed Adult Cardiac Surgical Procedures in Calendar Year 2014a

Outcomes

CABG

AVR

MV MV Repair ?

AVR ? CABG MVR MVR ? CABG Repair

CABG

Operations, No. Mortality, %

In-hospital Operativeb Major morbidity, % Reoperationc DSWI/mediastinitis Permanent stroke Prolonged ventilation >24 h Renal failure New-onset atrial fibrillation Readmission ................
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