March 20, 2017
The Society of Thoracic Surgeons (STS) National Database was established more than 25 years ago as a tool to improve the quality of care for heart and lung surgery patients. The STS National Database has three components, each focusing on a different area of cardiothoracic surgery— Adult Cardiac Surgery, Congenital Heart Surgery, and General Thoracic Surgery. The Database allows us to examine the results of our cardiothoracic operations and compare them to national outcomes. It is important to note that 90% of all hospitals performing adult heart surgery and 95% of all hospitals performing pediatric heart surgery in the US and Canada participate in the STS National Database.
In my own practice, STS National Database data helped me identify areas for improvement. At first, I would look at our own group’s results and think that the data were wrong; they didn’t necessarily reflect how good I thought we were doing. A number of other surgeons felt the same way, but it wasn’t long before reality sunk in, and we had to address some of our weaknesses.
The importance of this for you—as patients or family and friends of our patients—is that over the 25-year period, we have seen significant improvements in our surgical results and greater patient safety. This progress is in large part related to the “self-examination” of our practices, which on occasion has been humbling for the surgeons, but necessary and very beneficial for the patients.
The Database is also important because it contains information from millions of patients that is used to create risk models. With the help of the STS Risk Calculator, doctors are able to calculate the predicted risk of death and complications for individual patients. So now, when you go to your primary care physician, cardiologist, pulmonologist, oncologist, or cardiothoracic surgeon, they can collect data about your current problem, in addition to your age and details about other health issues that you might have, such as diabetes, high blood pressure, kidney problems, frailty, etc., and enter the information into the STS Risk Calculator. The Calculator provides us with information about your risk for each one of our operations. We can share that information with you if we are discussing a procedure to treat your problem. You and your family then can make a well-informed decision, as can your surgeons and referring doctors.
If you are found to need a coronary bypass, valve replacement, , the Calculator will estimate your likelihood of surviving the operation and/or not having complications. For example, if there is an 80-year-old patient who needs a coronary bypass and has diabetes, hypertension, and previous stroke, compared to a 60-year-old patient with no diabetes, hypertension, or stroke, there will be considerable differences in their risks for the operation. All of this helps us explain to you the relative risks versus the benefits of doing or not doing a procedure.
Approximately 60% of adult cardiac surgery programs and 63% of pediatric heart surgery programs in the US and Canada publicly report, on a voluntary basis, their heart surgery scores and star ratings on the STS Public Reporting website, the Consumer Reports website, or both. Therefore, if you have a problem that requires a visit with a cardiothoracic surgeon, you can check if the surgeon is in one of the groups that publicly reports. If so, you can review their results.
The publicly reported results include a star rating system. One star indicates a group’s performance was lower than expected; two stars shows a performance that is as expected; and three stars demonstrates a performance that is better than expected. Very importantly, when you talk to your surgeon, ask about his/her experience with the specific operation you need, including how often he/she has performed the surgery and what the results have been. Most of us will gladly share that with our patients, and we would want the same information if we personally needed an operation.
Another way that the STS Database has improved your care is by analyzing specific data for research studies aimed at better understanding and treating the health problems that you may face. Since the launch of the Database, there have been several hundred scientific publications using data from the STS Database. This research has given us important information on how to better perform operations and make more informed decisions. For example, we’ve learned from research based on the Database data that if you need a coronary artery bypass to the artery on the front of your heart, it is best performed using the left internal mammary artery which runs behind the left side of the breast bone. This artery has been shown to stay clear for 10 or more years in more than 90% of patients.
I hope this information has been helpful to you and that you will continue to visit the STS Patient Blog.
More information on the STS National Database can be found here.
The opinions expressed in this article are those of the author and do not necessarily reflect the views of The Society of Thoracic Surgeons.
The STS mission is to advance cardiothoracic surgeons’ delivery of the highest quality patient care through collaboration, education, research, and advocacy.