lessons learned from the society of thoracic surgeons (sts) congenital database september 25, 2015...

Lessons Learned from the Society of Thoracic Surgeons (STS) Congenital

Database

September 25, 2015

Robert J. Dabal, MD

Associate Professor of Surgery

I do not have any relevant financial relationships with any commercial interests to disclose.

While not an expert on the subject, I did serve on the STS Congenital Surgery Database Task Force for about 4 years.

Overview

History of the STS database

Applications

Quality Improvement

Research

Limitations

Future Directions

History of the STS Database

Founded in 1989

Quality improvement and safety initiative of the STS

Adult cardiac and thoracic, followed by congenital

Joint effort of the STS Congenital Database Task Force and the Duke Clinical Research Institute (DCRI)

History of the STS Congenital Database

Congenital database started in 2002

116 North American congenital participants representing 127 hospitals

124/125 US hospitals, 3/8 Canadian hospitals

History of the STS Congenital Database

History of the STS Congenital Database

History of the STS Congenital Database

History of the STS Congenital Database

Database structure

One harvest per year from 2004 to 2007

Two harvests per year beginning in 2008 – Spring and Fall

23rd harvest – today

4 year span – July 1, 2011 to June 30, 2015

• 149,780 operations in last harvest

Quality Improvement

How do we compare?

Mortality

Patient mix/ preoperative factors

Operative times

Length of stay

Complications

Quality Improvement

Data summary

Risk adjusted mortality

Participant specific outcomes (benchmarks)

Lesion specific outcomes

Missing data summary

Quality Improvement

Data Summary

Patient and procedure volume

Discharge mortality

Procedural complexity

By participant center

By age groupings

Frequency of all diagnoses and procedure types

Quality Improvement

Risk-adjusted mortality

UAB/Children’s of Alabama 2015

250 index operations (high volume center)

5 total deaths

2% overall mortality, STS 3.3%

STAT, RACHS-1

Quality Improvement

Patient specific outcomes (Benchmark operations)

Quality Improvement

Lesion specific outcomes

Demographics

Preoperative factors

Non-cardiac abnormalities

Operative information

Complications

Mortality

Quality Improvement

Missing data

Research

Initial publications in April 2000

Total of 65 publications over 15 years

Descriptive (43)

Methodology, risk stratification

Comparative, linkages (9)

Lesion, operation or patient specific outcomes (12)

Research

Descriptive (43)

Mostly early papers - methodology

Later papers on definitions, clarifications and risk stratification

Research

Comparative, linkages (9)

Other databases, social security, CHSS

Research

Congenital Heart Surgeon’s Society

Founded in 1985 by Dr. John W. Kirklin and Dr. Eugene Blackstone

Data center housed at UAB for first decade

Dr. James K. Kirklin, current research chair

Research

Lesion, operation or patient specific outcomes (12)

Limitations

Definitions change – moving target

Spring Harvest – changes in operative mortality from hospital discharge to database discharge

Fall Harvest – new methodology for determining primary procedure – highest STAT score

Retrospective to include all 4 years

Limitations

Missing data

Greater than 10% missing data excluded

Approximately 10% audited per year

Limitations

Only 50 of 116 programs participate in the Congenital Cardiac Anesthesia Society (CCAS) module

Over 64,000 anesthetic records

Anesthesia tracking is not available for procedures done by providers with IDs

Limitations

Voluntary public reporting began in January 2015

Available only for programs, not surgeons

Opt-in not available until Spring 2016

Limitations

Public reporting

8 variables in the mortality risk model – age group, primary procedure, weight, prior cardiothoracic operation, non cardiac abnormalities, chromosomal abnormalities, prematurity and 6 preoperative factors

Future Directions

More robust data collection

Higher rate of audits

Linkage to other databases – PC4, ACC

Mandatory participation

Better system of public reporting

Limited rankings

Proof of safety – standard of care

Summary

The STS congenital database is a valuable resource for clinicians in both the areas of quality improvement and research.

The cumulative experience is growing dramatically and will continue to do so over the next decade.

A successful program can not be evaluated solely on the basis of the STS congenital database.

Thank you for your attention