Current quality reporting methods are not adequate for salvage cardiac operations

Area of Science:

• Cardiac Surgery Outcomes Research
• Health Services Research
• Surgical Risk Stratification

Background:

• Cardiac surgery outcomes are benchmarked using national Society of Thoracic Surgeons (STS) data.
• Accurate risk adjustment is crucial to prevent risk-averse behavior in surgical decision-making.
• The heterogeneity and infrequent nature of salvage operations may challenge existing risk calculators.

Purpose of the Study:

• To evaluate the adequacy of the STS risk calculator in characterizing the risk of salvage cardiac surgery operations.
• To compare observed-to-expected (O:E) ratios for mortality and morbidity/mortality across different operative statuses.

Main Methods:

• Extracted data from a regional database of 19 cardiac surgery centers (2002-2017).
• Included patients with an STS predicted risk score.
• Stratified patients by operative status (elective, urgent, emergent, salvage) and calculated O:E ratios for mortality and composite morbidity/mortality.

Main Results:

• Salvage patients exhibited significantly higher mortality than expected (O:E ratio = 1.41, P = .04).
• Composite morbidity/mortality was higher than expected for emergent (O:E ratio = 1.13) and salvage (O:E ratio = 1.24) cases.
• Observed-to-expected ratios for salvage mortality showed significant variability across the 19 centers.

Conclusions:

• Current STS risk models do not accurately predict outcomes for salvage cardiac surgery.
• Recommendations include more detailed reporting of salvage outcomes to mitigate risk aversion.
• Improved risk stratification is needed for these potentially life-saving interventions.