The STS Cardiac Surgery National Database: an update

Area of Science:

• Cardiovascular Surgery
• Health Services Research
• Medical Informatics

Background:

• The Society of Thoracic Surgeons (STS) National Cardiac Database, established in 1990, has expanded to include over 1,500 surgeons across 706 hospitals.
• The database encompasses over half a million patient records, with participation geographically proportional to heart surgery centers in all 49 operating states.

Purpose of the Study:

• To analyze the impact and evolution of the STS National Cardiac Database on cardiac surgery outcomes and practices.
• To highlight new applications of the database for quality improvement and clinical pathway development.

Main Methods:

• Analysis of aggregated patient data from the STS National Cardiac Database.
• Tracking changes in length of stay, operative mortality, and case mix for cardiac procedures.

Main Results:

• A significant decrease in length of stay for most cardiac operations.
• A modest reduction in coronary artery bypass grafting (CABG) operative mortality from 3.7% to 3.3% over three years.
• A shift in CABG case mix, with a 17% decline in low-risk cases and an increase in higher-risk cases (5-10% and above).

Conclusions:

• The STS National Cardiac Database has facilitated improvements in cardiac surgery outcomes, including reduced length of stay and operative mortality.
• The peer-reviewed risk-stratification system is key to the database's acceptance and ongoing refinement.
• Future efforts will focus on expanding participation, particularly from general thoracic surgeons for lung cancer cases.