FAQ - 3

Frequently Asked Questions: Adult Cardiac Database Version 2.41 The Society of Thoracic Surgeons National Database Program March 2004 \| Section 1 (10-1400) \| Section 2 (1420-2350) \| Section 3 (2360-4680) \| Section 4 (4760-5690) \| Click on Seq # in this area to go directly to that field in the FAQ. Seq#: 1670, Meds-ACE Inhibitors - CORRECTION TO PREVIOUSLY ANSWERED QUESTION Seq#: 5332, Ace-Inhibitors - Discharge Click Here to see letter from Paul Meehan at DCRI, Accepting Zero Values. For fields pertaining to this letter look for red asterisk in NEW column.
NEW	Date	SeqNo	FieldName	Definition
		2360	VS-Mitral Proc-Procedure	Was a surgical procedure done on the Mitral Valve, and if so what? Select one of the following: No; Annuloplasty Only; Replacement; Reconstruction with Annuloplasty; Reconstruction without Annuloplasty.
		2370	VS-Tricuspid Proc-Procedure	Was a surgical procedure done on the Tricuspid Valve, and if so what? Select one of the following: No; Annuloplasty Only; Replacement; Reconstruction with Annuloplasty; Reconstruction without Annuloplasty; Valvectomy
		2380	VS-Pulmonic Proc-Procedure	Was a surgical procedure done on the Pulmonic Valve, and if so what? Select one of the following: No; Replacement; Reconstruction.
		2510	Other Card	Was another type of cardiac procedure done (other than CABG and/or Valve procedures)?
		2520	Other Non Card	Was a non-cardiac procedure done?
		2550	Unplanned CABG	The patient required unplanned CABG after catheterization or an interventional procedure such as PTCA, stent, or atherectomy. In the opinion of the operator or the responsible physician, the patient needed to be moved directly to surgery from the cath lab or hospital ward, typically due to indications such as ongoing ischemia, rest angina despite maximal treatment, pulmonary edema requiring intubation, or shock.
		2570	Dist Anast - Art #	The total number of distal anastomoses with arterial conduits, whether IMA, GEPA, radial artery, etc.
		2580	Dist Anast - Vein #	The total number of distal anastomoses with venous conduits, e.g. saphenous veins.
		2590	IMA Artery Used	Specify which, if any, Internal Mammary Artery(ies) were used for grafts.
		2660	IMA Dist Anast #	Total number of distal anastomoses done using internal mammary artery grafts.
		2670	Radial Artery Used	Indicate which radial artery(ies) was/were used for grafts: No Radial artery. Left Radial artery. Right Radial artery. Both Radial arteries.
		2680	Radial Dist Anast #	Total number of distal anastomoses done using radial artery grafts.
		2700	GEPA Dist Anast #	Total number of distal anastomoses done using gastro-epiploic artery grafts.
		3240	VS-Aortic Proc-Imp-Type	Indicate the type of implant; choose one: None M = Mechanical B = Bioprosthesis H = Homograft A = Autograft R = Ring/Annuloplasty
		3250	VS-Aortic Proc-Imp	Select the name of the prosthesis implanted.
		3260	VS-Aortic Proc-Imp-Size	Valve Surgery - Aortic Procedure - Implant Size
		3270	VS-Aortic Proc-Exp-Type	Indicate the type of explant; choose one: None M = Mechanical B = Bioprosthesis H = Homograft A = Autograft R = Ring/Annuloplasty
		3280	VS-Aortic Proc-Exp	Select the name of the prosthesis explanted.
		3290	VS-Aortic Proc-Exp-Size	Valve Surgery - Aortic Procedure - Explant Size
		3300	VS-Mitral Proc-Imp-Type	Indicate the type of implant; choose one: None M = Mechanical B = Bioprosthesis H = Homograft A = Autograft R = Ring/Annuloplasty
		3310	VS-Mitral Proc-Imp	Select the name of the prosthesis implanted.
		3320	VS-Mitral Proc-Imp-Size	Valve Surgery - Mitral Procedure - Implant Size
		3330	VS-Mitral Proc-Exp-Type	Indicate the type of explant; choose one: None M = Mechanical B = Bioprosthesis H = Homograft A = Autograft R = Ring/Annuloplasty
		3340	VS-Mitral Proc-Exp	Select the name of the prosthesis explanted.
	11/03	3340	VS-Mitral Proc-Exp	Patients procedure is a MVR. A mechanical valve is used as the replacement. How do I code the explant information? Do I leave it blank or put in none	If the patient is having a first time MVR then the explant would be coded as none. If the patient is having a redo MVR and there is documentation of the valve prosthesis removed, the removed prosthesis code would be coded in the explant area. If the removed valve prosthesis type is unknown, leave blank.
		3350	VS-Mitral Proc-Exp-Size	Valve Surgery - Mitral Procedure - Explant Size
		3360	VS-Tricuspid Proc-Imp-Type	Indicate the type of implant; choose one: None M = Mechanical B = Bioprosthesis H = Homograft A = Autograft R = Ring/Annuloplasty
	7/03			What is the correct way to enter implant type for a DeVega Annuloplasty? Since it is a suture Annuloplasty there isn't really an implant. I have been entering the implant as none but we have differences in opinion so would like your help.	You are correct to enter the implant type as "none" for a DeVega Annuloplasty.
		3370	VS-Tricuspid Proc-Imp	Select the name of the prosthesis implanted.
		3380	VS-Tricuspid Proc-Imp-Size	Valve Surgery - Tricuspid Procedure - Implant Size
		3390	VS-Tricuspid Proc-Exp-Type	Indicate the type of explant; choose one: None M = Mechanical B = Bioprosthesis H = Homograft A = Autograft R = Ring/Annuloplasty
		3400	VS-Tricuspid Proc-Exp	Select the name of the prosthesis explanted.
		3410	VS-Tricuspid Proc-Exp-Size	Valve Surgery - Tricuspid Procedure - Explant Size
		3420	VS-Pulmonic Proc-Imp-Type	Indicate the type of implant; choose one: None M = Mechanical B = Bioprosthesis H = Homograft A = Autograft R = Ring/Annuloplasty
		3430	VS-Pulmonic Proc-Imp	Select the name of the prosthesis implanted.
		3440	VS-Pulmonic Proc-Imp-Size	Valve Surgery - Pulmonic Procedure - Implant Size
		3450	VS-Pulmonic Proc-Exp-Type	Indicate the type of explant; choose one: None M = Mechanical B = Bioprosthesis H = Homograft A = Autograft R = Ring/Annuloplasty
		3460	VS-Pulmonic Proc-Exp	Select the name of the prosthesis explanted.
		3470	VS-Pulmonic Proc-Exp-Size	Valve Surgery - Pulmonic Procedure - Explant Size
		3478	Cardiopulmonary Bypass Used	Indicate if Cardiopulmonary Bypass was used at anytime during the procedure
		3479	Conversion to CPB	Indicate whether the patient needed to be placed on cardiopulmonary bypass after the off-pump procedure was attempted.
		3480	Indication	Select the primary indication why the minimally invasive approach was chosen: Not minimally invasive. Surgeon and/or patient choice. Contraindication to standard approach. Combined with Catheter Intervention.
	4/03	3480	Indication	Definition for minimally invasive: Any procedure that has not been performed with a full sternotomy and CPB support. All other procedures, on or off pump with a small incision or off pump with a full sternotomy are considered minimally invasive.
		3490	Primary Incision	Select the primary incision used as the initial intention for treatment: Full Sternotomy Partial Sternotomy Transverse Sternotomy Right Vertical Parasternal Left Vertical Parasternal Right Ant Thoracotomy Left Ant Thoracotomy Posterolateral Thoracotomy Xiphoid Epigastric Subcostal
		3500	Total Number of Incisions	Total number of incisions, including portholes in chest and other locations such as groin or neck, for cannulation or instrumentation access.
	5/03	3500	Total Number of Incisions	The intent is to capture surgical approach incisions for visualization of anatomy and incisions made for cannulation (skin). These refer to skin incisions only, not tissue incisions. Include: sternal incisions, portholes for instrumentation, cannulation for instrumentation (external incisions for instruments necessary to perform thoroscopic, endoscopic, robotic, heart port etc. procedures) Do not include internal cannulation Exclude: chest tube insertion sites, pacing wires, IABP insertion sites, bypass access (internal cannulation), SVG, a-lines, vein and/or artery harvest sites
		3510	Conversion to Std Incision	Indicate whether the minimally invasive incision was converted to a full median sternotomy.
		3520	Conversion Indication	If a minimally invasive incision was made but then converted to a standard median sternotomy, select the primary indication for the conversion to full median sternotomy: Not minimally invasive Inadequate Exposure Bleeding Rhythm Problems Hypotension Conduit Trauma or Quality.
		3760	Cannulation Method	Indicate the method of cannulation used for cardiopulmonary bypass (select one): None (no CPB). Aorta and Femoral/Jugular Vein. Femoral Artery and Femoral/Jugular Vein. Aorta and Atrial/Caval. Femoral Artery and Atrial/Caval. Other.
		3880	Aortic Occlusion	Indicate if aortic occlusion was used, and if so, by which method: None Aortic Crossclamp Balloon Occlusion.
	11/03	3880	Aortic Occlusion	Our institution has recently performed a couple of CABGs using a "partial aortic occlusion clamp." Would a partial aortic occlusion count as "None" or "Crossclamp"?	Using a 'side bite', partial or J-clamp should be entered as Crossclamp. Even through it is a partial or side bite there is still clamping of the aorta which can still create the negative events associated with cross clamping the aorta (i.e. calcification, plaque etc. release). It has been suggested by some that a side bite or partial clamp can be equivalent to a full cross clamp in relation to the potential embolic events.
		3930	Intracoronary Shunt Used	Intracoronary Shunt was used during distal anastomoses.
		4040	Suture Technique	Primary suture technique used for distal anastomoses.
	4/03	4040	Suture Technique	If my surgeon just does a valve procedure, would I document the suture technique used for this procedure?	No, per the definition, the intent is to capture the primary suture technique used for distal anastomoses in CABG only.
		4050	Vessel Stabilization	Indicate if any technique was used for coronary artery stabilization during the anastomoses, and which one: None Suture Snare Suction Device Compression Other
		4070	IMA Harvest Technique	Technique of IMA Harvest
		4080	Flow/Patency Check	Indicate if any flow/patency study was done in the acute perioperative period, and what type. (Do not include any late followup studies). Select one: None; IntraOperative Doppler study; IntraOperative Angiogram; Postoperative Angiogram; Postoperative Doppler study.
		4150	Other Card-LVA	Other Cardiac Procedure - Left Ventricular Aneurysm Repair
		4160	Other Card-VSD	Other Cardiac Procedure - Ventricular Septal Defect Repair
		4170	Other Card-ASD	Other Cardiac Procedure - Atrial Septal Defect Repair
		4180	Other Card-Batista	(Left Ventricular Reduction Myoplasty) A Procedure whereby left ventricular myocardium is excised to reduce left ventricular volume in patients with a dilated cardiomyopathy, with or without mitral valve replacement or repair. If a concomitant valve procedure is performed, please check that category also.
		4185	Other Card-Surgical Ventricular Restoration	Surgical Ventricular Restoration includes procedures that restore the geometry of the heart after an anterior MI. They include the Dor procedure or the SAVER procedure. This SVR procedure is distinct from an anterior left ventricular aneurysmectomy (LVA) and from a Batista procedure (left ventricular volume reduction procedure).
		4190	Other Card-Congenital	Other Cardiac Procedure - Congenital defect repair
	8/03	4190	Other Card-Congenital	Would repair of a foramen ovale fall under Other Cardiac Procedures Other?	No, code a foramen ovale repair under Other Cardiac Procedures Congenital Defect Repair.
		4200	Other Card-Transmyocardial	Creation of multiple channels in left ventricular myocardium with a laser fiber.
		4210	Other Card-Cardiac Trauma	Other Cardiac Procedure - Cardiac Trauma
		4220	Other Card-Card Tx	Cardiac Transplant: Heterotopic or Orthotopic heart transplantation
		4230	Other Card-Pacemaker	Other Cardiac Procedure - Permanent Pacemaker
		4240	Other Card-AICD	Other Cardiac Procedure - Automatic Implanted Cardioverter Defibrillator
		4250	Other Card-Other	Other Cardiac Procedure Other
	4/03	4250	Other Card-Other	Would coronary endarterectomy be captures here?	No, the STS believes that coronary endarterectomy is not significant enough of a procedure to be considered as the other in CABG + other procedure. Therefore, if the coronary edarterectomy is not included the CABG will be coded as CABG only.
		4260	Other Non Card-Ao Aneur	Aortic Aneurysm/Dissection repair.
		4320	Other Non Card-Caro Endart	Surgical removal of stenotic atheromatous plaque.
		4330	Other Non Card-Other Vasc	Procedures correcting peripheral vascular occlusion.
		4340	Other Non Card-Other Thor	Procedures involving Thorax/Pleura.
		4347	Skin Incision Start Time	Document to the nearest minute (using 24-hour clock) the time the skin incision was made.
				At the data managers meeting in January 2002, we were told that skin incision start time means any incisions started. This definition does not specify this. How do we know what time to record?	The new data definition should refer to the first incision make no matter where the incision is made. By OR standards, this is generally recorded on the OR record as the time the procedure began as opposed to the time the patient entered the OR suite. Since multiple incisions can be made in any procedure and since generally the only time documented on OR records for any of these incisions to be made is the first incision, it seems reasonable to conclude that you can only record that one time. (3-25-02)
				If the data is to be entered in a number format and not a time format, the total minutes can not be calculated.	The data for both the start and stop times is to be written in a time format using military time including minutes. The total number of minutes between start and stop times can be a custom field added. (4-19-02)
		4348	Skin Incision Stop Time	Document to the nearest half hour (using 24-hour clock) the time the skin incision was closed; if the patient leaves the OR with an open chest, collect the time the dressings are applied to the incisions.
*		4350	Cross Clamp Time (min)	Total number of minutes the aorta is completely cross-clamped during bypass. Leave Blank if no cross-clamp was used.
		4350	Cross Clamp Time (min)	The definition calls for the user to leave this field blank if no cross clamp was used. Some on-pump procedures do not use a cross clamp. Zero is a different value from NULL or missing. How do I determine if a clamp time was zero vs. the person entering the data did not know, or inadvertently omitted the data? How do I get an average clamp time if some of the values are blank? Again, zero is a real legitimate value; blank gives no useful information.	For this field, 0 is not an appropriate answer due to the relationship with the parent field, CPB used: Yes/No. (4-19-02)
*		4360	Perfusion Time (min)	Total number of minutes on cardiopulmonary bypass. Leave Blank if no cardiopulmonary bypass was used.
	7/03	4360	Perfusion Time (min)	Post CT surgery a patient has a Reop/Bleed requiring surgery and the use of cardiopulmonary bypass. Do the minutes for perfusion time of the second surgery get added to the perfusion time for the first surgery or do we only record the perfusion time for the first procedure and not record the perfusion time for the Reop/Bleed?	Only record the perfusion time for the first surgery.
		4380	Cardioplegia	Cardioplegia
		4480	IABP	Was the patient placed on Intra-Aortic Balloon Pump (IABP)?
		4490	IABP-When Inserted	What was the time of earliest IABP insertion? Choose one of the following: Preoperatively. Intraoperatively. Postoperatively.
		4500	IABP-Indication	What was the PRIMARY reason for inserting the IABP? Choose one of the following: Hemodynamic Instability. PTCA Support. Unstable Angina. Cardiopulmonary bypass (CPB) weaning failure. Prophylactic.
		4550	VAD	Ventricular Assist Device Was a VAD used at the time the patient left the operating room?
		4630	Blood Prod	Were Blood Products transfused postoperatively? Do not include: 1. Pre-donated Blood 2. Cellsaver Blood 3. Pump Residual Blood 4. Chest Tube Recirculated Blood
	5/03			How should blood that is started in the OR and finished in the ICU be counted?	Per the definition, blood that is pre-donated (autologous) blood, cell saver, pump residual and /or chest tube recirculated blood are not considered as having a transfusion. If blood is started in the OR then it is not considered a postoperative transfusion. Blood started after the patient leaves the OR is considered a postoperative transfusion.
	5/03			Please define blood products.	Blood products include FFP, RBC, cryo, platelets and whole blood
*		4676	Initial Hours Ventilated	Indicate the number of initial hours post operation for which the patient was ventilated before any reintubation. Number of hours includes hours ventilated post-operatively till removal of the endotracheal tube or if patient has tracheostomy tube, till no longer ventilator dependent. Leave blank if the patient was extubated on the operating table. Any patient ventilated > 24 hours is coded as a Pulmonary Complication of "Prolonged Ventilation"
				How should postop vent hours be counted? The definition calls for leaving this field blank if extubation occurs on the table. There are two practical problems associated with using a blank for extubation on the table. First, there will be an assumption of on-table extubation when the field may have been left blank due to lack of information, careless omission or other error. Second, the vendors have the option of making Post Op Vent Hours Total a calculated field. Consider the following not-uncommon scenario: The patient is extubated on the table, transported to the ICU where re-intubation is required for 10 hours. With a calculated field, Post Op Vent Hours Total = <NULL> + 10 = <NULL>. Both of these problems are solved by using 0 for Initial Hours Ventilated when extubation is on the table.	Initial hours ventilated should include the hours from postop intubation time to time of extubation. This does not include re-intubation time. Re-intubation should be reported under Additional Hours Ventilated. For centers extubating in the OR, the Postop Vent Hours = 0. (4-19-02)
	6/03			Should post-op vent time start at the end of surgery or when the patient leaves the OR or when the patient arrives in the ICU?	Post-op vent times begin when the patient arrives in the ICU or your institutions equivalent to an ICU.
	7/03			If you have a patient that is extubated post-op but maintained for two days on bi-pap to prevent reintubation, does the bi-pap time count towards initial hours ventilated?	The intent of this field is to capture the number of hours that a patient was ventilated postoperatively till removal of the endotracheal tube. Therefore, once the patient is extubated, stop counting initial hours ventilated.
		4678	Re-intubated During Hospital Stay	Was the patient re-intubated during the hospital stay after the initial/planned extubation?
	8/03	4678	Re-intubated During Hospital Stay	I had a patient return to the OR which required intubation. Patient was extubated prior to leaving the OR. Is this a reintubation?	No, this would not be a reintubation because it was a required intubation for the surgery. As long as the patient was extubated in the OR, there is no reintubation and no additional vent hours.
*		4679	Additional Hours Ventilated	How many additional hours was the patient ventilated postoperatively?
*		4680	Postop Vent Hours - Total	Total number of hours including any re-intubation hours. Any patient ventilated > 24 hours is coded as a Pulmonary Complication of "Prolonged Ventilation"
				The variable for post-op vent hours is defined as an integer. Are there rounding rules that have been standardized for use by all hospitals? Since vent ours are rarely integer values, would it be possible to change the definition to numerical to allow for decimals?	The recommendation is to round to the nearest hour. If the patient is intubated 15.25 hours, it would translate to 15. If the patient was intubated 15.35 hours, it would translate to 16 (3-25-02).
	9/03			Does prolonged intubation include those hours after the initial extubation which may have been less than 24hrs? Also if a patient was trached and was on trach shield during the day but back on the vent at night, do we include those vent hours?	Total vent hours included all hours until patient is non-vent dependent. It does include all reintubation hours (excluding re-op OR intubation hours) and those hours of trach collar/vent at night hours.