STS National Database Definition Clarification

Definition Issue	Current Definition	Revised Definition
CVA Preoperative and Postoperative timeframes differ	CVA – A central neurological deficit persisting more than 24 hours (preoperative) CVD – CVA – symptoms > 72 hours after onset (preoperative) CVA – A central neurological deficit persisting for > 72 hours (postoperative)	The timeframes for all parameters are to be 72 hours Preoperative CVA changes form 24 to 72 hours
CVD (type) Definition doesn’t account for previous carotid surgery	CVD – Whether the patient has CVD, documented by any one of the following: Coma, CVA, RIND, TIA, or non-invasive carotid test >75% occlusion	Add prior Carotid Surgery into the definition Code any prior carotid surgery as CVD Type (non-invasive carotid test with > 75% occlusion) – interim solution
Renal Failure (Preoperative) Should "last creatinine preop" be collected on all patients or only renal failure patients.	The most recent creatinine prior to the day of surgery	A creatinine level should be collected on all patients for consistency. **It is most important to fill in a creatinine value as it is a high predictor of a patient’s outcome and is used in the Predicted Risk Models.
Renal Failure (Preoperative) No creatinine level is required to determine renal failure	Is there a documented history of renal failure?	Field Title to be changed to Renal Insufficiency Use a creatinine level of > 2.0 – interim solution
Morbid Obesity No longer part of the core data set, requests to add back into database	This field was deleted due to missing and inconsistently collected data, and the subjective nature of determining a frame size.	The certified software specifications automatically calculate a BSA that is the preferred method of determining morbid obesity. BSA is factored into all Predicted Risk Models. ((0.007184*(Height**0.725)*(Weight**0.425))

 

Definition Issue	Current Definition	Revised Definition
Preoperative Patient History Request for more timeframes for specific variables	Varying timeframes for Risk Factors, Cardiac Medications and PreOp Cardiac Status Medications** (Revised Definition) Within 24 hours of surgery: Digitalis Nitrates-IV Diuretics Steriods Inotropic Agents Beta Blockers Anticoagulants within 48 hours of surgery (include IIA, IIIB inhibitors) Aspirin within 5 days of surgery	Risk Factors – all risk factors are "timeless" except those with a specific time frame indicated. PreOp Cardiac Status – all variables have time frames except angina. Definition of angina to include "any angina present leading up to or during the hospitalization prior to the surgical intervention". Cardiac Medications- code medications as noted** (allows for the most active medications present at the time of surgery – variables that are in the Risk Models)
Preoperative MI Current definition doesn’t capture a history of a remote MI. Also a non-q wave MI wouldn’t be captured	Patient hospitalized for an MI documented in the medical record. Two of the following four criteria are necessary: prolonged (>20 min) typical chest pain not relieved by rest and/or nitrates, enzyme level elevation, new wall motion abnormality, serial ECG changes	Replace the words" hospitalized for an" with "with" in the first sentence of the definition Change "new" wall motion abnormality to "any" Expand the wall motion abnormality definition to include: " as documented by LV Gram, Echo, Muga Scan and/or EF<45%
NYHA and CCS Classifications Data managers are unclear how to apply these definitions	See Definition of Terms Booklet	CCS classification is for angina only. The NYHA classification was designed to be an overall functional status score that comprised both CHF and angina components. There currently isn’t a score ONLY for CHF. The CCS and NYHA classification scores "may" not be the same in each operative procedure.

 

Definition Issue	Current Definition	Revised Definition
Urgent Status (reasons) There currently isn’t a choice for a valve or other procedure that required urgent surgery	AMI, IABP, Worsening, sudden chest pain, CHF, Coronary anatomy, USA with IV NYG, Rest angina	See Software Specification Changes Additional urgent reasons will be added for other types of surgery
MICS Section The definition of a minimally invasive surgery is unclear. Data Managers would like to collect all components on all surgical procedures.	Was a minimally invasive procedure done or attempted?   ***Until further development of software specifications, collect per the Definition of Terms Booklet	See Software Specification Changes. This section is to be revised and changed to OPERATIVE TECHNIQUE instead of MICS. A new field of conversion to CPB would be added.
Re-Intubation (# Hours Ventilated Postop) Current definition doesn’t allow capture of a patient that has been extubated requiring re-intubation	Indicate the number of hours post operation for which the patient was ventilated. Use zero if the patient was extubated on the operating table. ***# hours ventilated post-op refers to time to removal of endotracheal tube or if tracheostomy tube inserted till no longer ventilator dependent	Code the total number of hours (including any re-intubation hours) in the data field Code any patient ventilated > 24 hours as a Pulmonary Complication – "Prolonged Ventilation" Enhance current "Prolonged Ventilation" definition to include: "and/or any patient ventilated > 24 hours postoperatively".
ReOp for Bleed and Tamponade Which fields should be appropriately coded for each or both complications	ReOp for Bleed – operative re-intervention was required for bleeding Tamponade – fluid in the pericardial space compromising cardiac filling, and requiring intervention.	"ReOp for Bleed" title changed to "ReOp for Bleed/Tamponade" and the definition to state "any return to the OR for acute bleeding or cardiac compromise in the immediate postoperative period". Tamponade definition clarified to include: "Does not include an acute re-exploration to the OR".

 

Definition Issue	Current Definition	Revised Definition
Postop Wound Infections Data Managers are requesting that the Superficial Sternal Wound Infection field be added back into the core set	Current definitions include, Infect-Sternum Deep, Infect-Thoracotomy, and Infect-Leg	The STS doesn’t analyze this piece of data in the national reporting, therefore deleted from the core data set. It is suggested that this should be collected as a customized field if desired.
Renal Failure (Postoperative) Patient with a low baseline creatinine level may be coded with renal failure (i.e., preop creat 0.6, postop creat 0.9) Postoperative renal failure includes for renal insufficiency and renal failure. No breakout for patients requiring dialysis	Acute postoperative renal insufficiency resulting in one or more of the following: increase of serum creatinine to > 2.0, 50% or greater increase in creatinine over baseline preoperative value, a new requirement for dialsis	Definition changed to: Renal insufficiency is a creatinine level > 2.0 & 2x the baseline preoperative creatinine level Renal failure is a patient requiring new dialysis Code both in the renal failure complication – interim solution
Valvular Complications Requests for all valve complications be added back into the core data set	Op-ReOp Valve Dysfunction & Other-Anticoagulant Complication are the valve related complications collected	The STS felt that the previous valve complication category would be sufficiently captured by using these two fields.