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Author Spotlight: Advancing Cardiovascular Imaging - Introducing the Spatially Weighted Calcium Score for Early Disease Detection
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The STS AVR+CABG composite score: a report of the STS Quality Measurement Task Force

David M Shahian1, Xia He2, Jeffrey P Jacobs3

  • 1Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

The Annals of Thoracic Surgery
|March 25, 2014
PubMed

Insights

The Society of Thoracic Surgeons developed a new performance measure for aortic valve replacement (AVR) with coronary artery bypass grafting (CABG) surgery. This measure uses 3 years of data to identify higher or lower performing programs.

Area of Science:

  • Cardiovascular Surgery
  • Health Services Research
  • Quality Improvement

Background:

  • The Society of Thoracic Surgeons (STS) is creating composite performance measures for common adult cardiac procedures.
  • This study details the third composite measure, focusing on aortic valve replacement (AVR) combined with coronary artery bypass grafting (CABG) surgery.

Purpose of the Study:

  • To develop and validate a composite performance measure for AVR+CABG procedures.
  • To assess the reliability and discriminatory power of the composite measure.

Main Methods:

  • Utilized data from the STS Adult Cardiac Surgery Database (3-year and 5-year periods).
  • Employed STS risk model variables to adjust morbidity and mortality outcomes.
  • Compared composite measures using different data durations and Bayesian credible intervals (90%, 95%, 98%).
  • The final measure uses 3 years of data and 95% credible intervals, including risk-adjusted mortality and morbidity.

Main Results:

  • The median composite score was 91.0%.
  • 2.6% of programs were rated as lower performing (one-star) and 6.5% as higher performing (three-star).
  • Higher star ratings correlated with decreased morbidity and mortality.
  • Programs performing over 150 procedures had a higher percentage of three-star ratings compared to those performing 25-50 procedures.

Conclusions:

  • The STS successfully developed a composite performance measure for AVR+CABG.
  • The measure, based on 3-year data and 95% credible intervals, identified 9.1% of participants with unexpected performance levels.
Abstract

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