Outcomes analysis, quality improvement, and patient safety
The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2018 Update on Outcomes and Quality

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Through nearly 3 decades of iterative refinement, The Society of Thoracic Surgeons Adult Cardiac Surgery Database has evolved into one of the most comprehensive and respected clinical data registries in health care. It is a widely acknowledged exemplar for accurately benchmarking risk-adjusted outcomes in cardiac surgery and underpins all quality measurement and improvement activities of The Society of Thoracic Surgeons. This is the latest in a series of annual reports that outlines current national aggregate outcomes and volume trends in cardiac surgery and summarizes database-related work in quality measurement and performance improvement during the past year.

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Updated Overview of the ACSD

As of September 2017, the ACSD includes 1,119 participant groups comprising 3,107 surgeons from all 50 states in the United States, 10 sites in Canada, and 21 participants in 7 other countries. The anesthesiology module has 68 participants comprising 637 anesthesiologists, and the atrial fibrillation module has 15 participants.

From previously published data regarding expanding penetration of the ACSD, we estimate that it currently contains information on more than 95% of the adult cardiac

National Outcomes and Volume Trends in Adult Cardiac Surgery

The relative distribution of major cardiovascular operations performed in calendar year 2016 is shown in Figure 1. CABG remains the most commonly performed procedure, followed by isolated aortic valve replacement (AVR), combined CABG and AVR (CABG+AVR), mitral valve (MV), and operations for aortic aneurysms. The STS ACSD has developed risk-adjustment models 3, 4, 5 and composite quality ratings 13, 14, 15, 16 for seven major procedures that include isolated CABG, isolated AVR, AVR+CABG, MV

Quality Measurement

The STS Quality Measurement Task Force (QMTF) is responsible for developing STS risk models and performance measures. This process is a collaboration between clinical cardiothoracic surgeons and statisticians from Duke Clinical Research Institute.

NQF Measure Submissions

The NQF is a multiple-stakeholder organization whose goal is to improve health care quality through better measurement. NQF-endorsed quality measures are recognized as evidenced based and “best in class.” In June 2016 STS submitted three previously endorsed adult cardiac process measures and three new adult cardiac composite measures [10] to NQF for review under the NQF Surgery Project Phase 3. All measures were recommended for endorsement at NQF Surgery Project Standing Committee August 2016

Patient-Reported Outcomes

Patient-reported outcomes (PRO) are measures of patient physical and psychosocial well-being that are increasingly used in health care 26, 27, 28. PRO measures are reported directly by patients and may provide a more meaningful assessment of the response to treatment, and in turn, a more patient-centered way of comparing the effectiveness of different treatment alternatives. Several major organizations, such as the National Cancer Institute, American Cancer Society, Centers for Medicare and

Informatics Task Force

The Informatics Task Force was established in 2016 to provide a central computer science and informatics resource for the STS National Database and its individual components. Informatics, specifically medical informatics, is the intersection of computer science and medical care. During this past year, the Informatics Task Force has focused its efforts on the specification upgrades for the thoracic and congenital heart surgery databases and the use of Health Level 7 (Health Level Seven

Summary

The STS was one of the first specialty organizations to appreciate the value and importance of a comprehensive, accurate, and highly detailed clinical data registry to advance the quality and effectives of care for the cardiothoracic surgical patient. Now in its 28th year, the ASCD is the foundation of the Society’s activities in performance measurement, quality improvement, public reporting, and outcomes research in adult cardiac surgery. Ongoing improvements to the ACSD will continue to

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