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The STS Participant-Level, Multiprocedural Composite Measure for Adult Cardiac Surgery.

David M Shahian¹, Vinay Badhwar², Paul A Kurlansky³

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

The Annals of Thoracic Surgery

|August 9, 2021

Summary

This summary is machine-generated.

The Society of Thoracic Surgeons developed a new composite performance measure for adult cardiac surgery. This metric offers a comprehensive assessment of overall practice quality, improving upon individual procedure evaluations.

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Area of Science:

Cardiovascular Surgery
Quality Improvement
Health Outcomes

Background:

Current Society of Thoracic Surgeons (STS) performance measures assess individual adult cardiac procedures.
There was a need for a composite metric to evaluate overall participant performance across multiple common procedures.

Purpose of the Study:

To develop and validate a multiprocedural composite performance measure for STS Adult Cardiac Surgery Database participants.
To assess overall quality of adult cardiac surgery practices using a novel composite metric.

Main Methods:

Utilized 1- and 3-year data from the STS Adult Cardiac Surgery Database, including isolated CABG, AVR, MVr/MVR, and combined procedures.
Employed Bayesian hierarchical models with risk-adjusted mortality and morbidity endpoints to estimate composite scores.
Assigned star ratings (1-3 stars) based on the comparison of participant scores to the STS average composite score.

Main Results:

The 3-year analysis cohort included over 650,000 procedures.
Composite scores demonstrated a median of 94.7% (IQR, 93.6%-95.6%) for the 3-year window.
Risk-adjusted mortality rates decreased significantly across star ratings: 4.3% (1 star), 3.0% (2 stars), and 1.8% (3 stars).

Conclusions:

The STS participant-level, multiprocedural composite measure offers a comprehensive quality assessment.
This new metric provides highly reliable, overall quality evaluation for adult cardiac surgery practices.
The composite measure enhances the ability to assess and compare the performance of surgical participants.