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