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

4760

Comps-Complications

Did a postoperative complication occur during the hospitalization for surgery? This includes the entire postoperative period up to discharge, even if over 30 days.

If the Complications-Any field=”Yes,” then at least one of the Complications fields must be “Yes.”  This could present a problem for us because we track twice as many complications as the STS does.  If one of our own complications is “Yes,” then we put a “Yes” in the Any Complications-Any field.  Can we continue to do this?

To handle this, starting with the Spring 2002 harvest and analysis, the “Complications-Any” values in the report will be generated by looking at the individual complications fields, and not the “Complications” parent field.  That way, if you check Complications as “Yes,” but don’t check any of the complications we are looking at, it will not be counted in the analysis. (1-30-02)

If a patient is in acute atrial fibrillation and then converts to sinus rhythm pre-operatively, do we count his post-op atrial fib as a complication?

No. (4-19-02)

How should “complications” be coded for a patient who was unable to be weaned from cardiopulmonary bypass, and expired on the OR table?  Would the complications field, which is defined as “post-op” be entered as “No”?

The definition states “did a postoperative complication occur…”  Given this clinical scenario, Complications No/Yes would be coded as No (3-25-02).

4840

Comps-Op-ReOp Bleed/Tamponade

Operative re-intervention was required for bleeding/tamponade.

4850

Comps-Op-ReOp Vlv Dys

Operative re-intervention was required for valve dysfunction.

4860

Comps-Op-ReOp Gft Occl

Operative re-intervention was required for coronary graft occlusion.

4870

Comps-Op-ReOp Other Card

Operative re-intervention was required for other cardiac reasons.

4/03

Do AICD’s and pacemakers get captured in this section?

Only if the patient returns to the OR to have these devices placed (which rarely happens) otherwise these procedures would not be captured.

However, if the patient had a VTach/Fib arrest that required AICD placement, capture the arrest under section "R", seq #5270 Comp-Other- Cardiac Arrest.  If the patient did not arrest the AICD does not get captured.  If the patient was in heart block and required a pacemaker, capture the arrhythmia under section “R”, seq #5260 Comp-Other-Heart Block.

11/03

I have a patient that had a 1 vessel bypass and AVR procedure done, the patient was off pump, the chest was closed and they were about to transfer, the patient did not leave the OR bed or OR suite.  He then became hypotensive and had EKG changes.  They reopened the chest and went back on pump and did two more grafts.  Do I need to do another data entry or is this a complication from the first procedure and marked as a reop for other cardiac?

Postoperative is defined as the time period from when the patient leaves the OR until discharge.  So this scenario would not be captured in the complications section.  The complications section comes into play once the patient leaves the OR.  Since this patient did not leave the OR, the initial one vessel/AVR procedure and the subsequent two vessel procedure would be captured as one event, as the primary surgical procedure.

4880

Comps-Op-ReOp Other Non Card

Operative re-intervention was required for other non-cardiac reasons.  It does include minor procedures that do require a return to the operating room but does not include procedures performed outside the OR (i.e. GI Lab for peg tube, shunts for dialysis etc), but may include procedures such as tracheostomy, hematoma evacuation).

11/03

The following sternum related procedures would be captured under seq# 4880, as long as the patient returns to the OR.

1.        to close sternum, after sternum opened at the bedside

2.        to close sternum, after not being able to close sternum in the OR after initial CT procedure

3.        for sternal dehiscence procedures

4890

Comps-Op-Perioperative MI

A perioperative Myocardial Infarction (MI) is diagnosed by finding at least two of the following four criteria:

a. Prolonged ( > 20 min) typical chest pain not relieved by rest and/or nitrates.

b. Enzyme level elevation: either (1) CK-MB > 5% of total CPK; (2) CK greater than 2x normal; (3) LDH subtype 1 > LDH subtype 2; or (4) troponin > 0.2 micrograms / ml.

c. New wall motion abnormalities.

d. Serial ECG (at least two) showing changes from baseline or serially in ST-T and/or Q waves that are 0.03 seconds in width and/or > or + one third of the total QRS complex in two or more contiguous leads.

What is the time frame we should be using for Periop MI?

The periop interval begins at the time of entrance into the OR and ends with DC or death. (3-25-02)

4920

Comps-Infect-Stern Deep

A deep sternal infection involves muscle, bone, and/or mediastinum.

Must have one of the following conditions:

1.  Wound opened with excision of tissue (I&D)

2.  Positive culture

3.  Treatment with antibiotics

4930

Comps-Infect-Thoracotomy

An infection involving a thoracotomy or parasternal site.

Must have one of the following conditions:

1.  Wound opened with excision of tissue (I&D)

2.  Positive culture

3.  Treatment with antibiotics

4940

Comps-Infect-Leg

An infection involving a leg vein harvest site.

Must have one of the following conditions:

1.  Wound opened with excision of tissue (I&D)

2.  Positive culture

3.  Treatment with antibiotics

4960

Comps-Infect-Septicemia

Septicemia (Requires Positive Blood Cultures) postoperatively.

4970

Comps-Infect-UTI

UTI-Urinary Tract Infection (Positive Urine Cultures) postoperatively.

5000

Comps-Neuro-Stroke Perm

A central neurologic deficit persisting for > 72 hours.

12/03

Where would you code the postoperative complication of anoxic encephalopathy?

Anoxic encephalopathy is not captured in version 2.41.  Instead, are you able to capture the complication that led to the anoxic event?  Peri op MI/ Cardiac Arrest etc?

5010

Comps-Neuro-Stroke Trans

A transient neurologic deficit (TIA recovery within 24 hours;  RIND recovery within 72 hours)

5030

Comps-Neuro-Cont Coma >=24Hrs

New postoperative coma that persists for at least 24 hours.

5050

Comps-Pulm-Vent Prolonged

Pulmonary Insufficiency requiring ventilatory support - includes (but not limited to) causes such as ARDS and pulmonary edema and/or any patient ventilated > 24 hours postoperatively.

6/03

If a patient is ventilated prior to cardiac surgery, would prolonged vent be a complication?

Only if the hours ventilated post-op are > 24 hours.

5070

Comps-Pulm-Pulm Embolism

Pulmonary Embolism diagnosed by study such as V/Q scan or angiogram.

5100

Comps-Pulm-Pneumonia

Pneumonia diagnosed by one of the following: Positive cultures of sputum, blood, pleural fluid, empyema fluid, transtracheal fluid or transthoracic fluid; consistent with the diagnosis and clinical findings of pneumonia.  May include chest X-ray diagnostic of pulmonary infiltrates.

5/03

The definition for pneumonia as a post-op complication seems to indicate that pneumonia may only be entered as a complication if cultures substantiate the diagnosis.  Is this correct? 

After much discussion with the Definitions Task Force, a positive culture is not necessary to capture pneumonia as a complication.  I very much stand corrected and apologize to those Data Managers that received incorrect information. Cultures are not necessary if there are clinical findings consistent with the diagnosis of pneumonia.  There seems to be so few sputum cultures obtained these days, unless the patient is still intubated.  Please keep in mind that atelectasis and effusions do not necessarily indicate pneumonia.  Pneumonia is most often diagnosed by CXR.  Make sure that pneumonia is present and documented so that you are not over-coding pneumonia. 

5120

Comps-Renal-Renal Failure

Acute or worsening renal failure resulting in one or more of the following:

a. increase of serum creatinine to > 2.0 & 2x the baseline creatinine level

b. A new requirement for dialysis.

5130

Comps-Renal-Dialysis Req

Requirement for dialysis post procedure?

5220

Comps-Vasc-Ao Dissect

Dissection occurring in any part of the aorta.

5230

Comps-Vasc-Illiac/Fem Dissect

Dissection occurring in the iliac or femoral arteries.

5240

Comps-Vasc-Acute Limb Isch

Any complication producing limb ischemia.

5260

Comps-Other-Heart Block

New heart block requiring the implantation of a permanent pacemaker prior to discharge.

5270

Comps-Other-Card Arrest

A cardiac arrest documented by one of the following:

a. ventricular fibrillation

b. rapid ventricular tachycardia with hemodynamic instability

c. asystole.

5280

Comps-Other-Anticoag Comps

Bleeding, hemorrhage, and/or embolic events related to anticoagulant therapy.

6/03

Please clarify the timing on anticoagulant administration to capture an anticoagulation complication?  Are you looking to capture the patient that has a PCI, receives Plavix, then goes for a CABG, bleeds post op and has to return to the OR, or are you looking to capture patients that receive anticoagulation therapy post-op, Heparin, for their valve or CVA/embolic event and bleeds. 

The intent of the field is to capture those patients that bleed, hemorrhage and /or suffer an embolic event related to anticoagulant therapy received post-op. 

5290

Comps-Other-Tamponade

Fluid in the pericardial space compromising cardiac filling, and requiring intervention. This should be documented by either:

a. echo showing pericardial fluid and signs of tamponade such as right heart compromise, or

b. systemic hypotension due to pericardial fluid compromising cardiac function.

5300

Comps-Other-GI Comps

Postoperative occurrence of any GI complication including:

a. GI bleeding requiring transfusion

b. pancreatitis with abnormal amylase/lipase requiring nasogastric (NG) suction therapy

c. cholecystitis requiring cholecystectomy or drainage

d. mesenteric ischemia requiring exploration

e. other GI complication.

5310

Comps-Other-Multi Sys Fail

Two or more major organ systems suffer compromised functions.

5320

Comps-Other-A Fib

New onset of atrial fibrillation/flutter (AF) requiring treatment. Does not include recurrence of AF which had been present preoperatively.

8/03

Patient is on beta blockers post-op and titrating each day to give higher doses.  Second post-op day patient has two hour run of A Fib.  If during this run of A Fib the beta blocker is increased or an extra dose of beta blocker is given but no other drugs are given for this two hour period, would this be considered an A Fib complication?

The intent of this field is to capture new onset A Fib that requires treatment and not to capture a reoccurrence of A Fib which had been present pre-op.  If the patient did not have A Fib pre-op and this post-op A Fib is new in onset requiring treatment = a post-op A Fib complication. 

5331

DC Meds-Aspirin

Indicate whether or not the patient was discharged from facility on ASA.

5332

Ace-Inhibitors - Discharge

Indicate whether or not the patient was discharged from facility on ACE- Inhibitors.

NEW

3/04

When coding ACE (Angiotensin Converting Enzyme) Inhibitors, do not include ARB’s (Angiotensin II Receptor Blockers).

5333

Beta Blockers - Discharge

Indicate whether or not the patient was discharged on beta blockers.

5334

Lipid Lowering - Discharge

Indicate whether or not the patient was discharged from facility on any lipid lowering medication.

7/03

We often see orders to resume Statins a couple of weeks after discharge post CAB.  Do we indicate the patient went home on a lipid lowering medication, even though there is a couple week delay in starting it?

Yes, indicate that the patient went home on lipid lowering medication since the patient was instructed at discharge to begin taking the medication at a designated time.

5335

Other Antiplatelets - Discharge

Indicate whether or not the patient was discharged from facility on Other Anti-platelets.

5336

Discharge Location

Location to where the patient was discharged.

The new field for Discharge Location lists ECF/TCC and Nursing Home among the choices.  ECF and Nursing Home are used synonymously here.  Can you clarify?

Following are a couple of possibilities:  1) Your institution can make the decision to code all of these patients as ECF or Nursing Home; or 2) if your institution has an ECF/TCC onsite, code the patients discharge to the onsite ECF as ECF/TCC and patients discharge to a Nursing Home or off-site ECF could be coded as Nursing Home.  The Committee will be adding further clarification to this definition in the near future. (4-19-02)

9/03

If a patient is discharge to a Rehabilitation Hospital, how should this be categorized, “Other” or “Extended Care/TCU”?

Extended Care/TCU.

12/03

Suppose a patient is discharged to a nursing home for subacute rehabilitation (as opposed to acute nursing home care).  Would this be coded as Extended Care/TCU or Nursing Home?

The rational for the move to a facility should be reflected in the type of facility selected.  Therefore, maybe your area doesn't have a "rehab" facility but do have rehab capabilities within a “nursing home”. In this type of situation, code as an Extended Care/TCU and not a Nursing Home.  Again, look at the reason for transfer to code the not straight forward transfers. 

5337

Mort-Mortality

Patient death, either in hospital or long-term.

12/03

Within the mortality definition the term “long term” is utilized. Would you please define “long term.”  Is this w/in 30 days?  Is this indefinite?

The mortality field is to be coded “yes” when the patient is identified as a death.  This could be while the patient is in the hospital for the current procedure, within 30 days of the procedure or "long term" meaning whenever the patient dies in the future.  This could be six months, five years, or anytime in the future.

5340

Mort-DC Status

Specify whether the patient was alive or dead at discharge from the hospitalization in which surgery occurred.

Has the STS considered a Parent/Child relationship between Discharge Status and Readmit<=30 Days?  If Discharge Status=Dead, then Readmit<=30 Days from date of procedure =No.

This is a good suggestion for the future.  In the meantime, you may be able in your own software to autopopulate this field as such in these instances.  (4-19-02)

5350

Mort-30d Status

Specify whether the patient was alive or dead at 30 days post surgery (whether in hospital or not).

5355

Mort-Op Death

Operative Mortality:  Includes both (1) all deaths occurring during the hospitalization in which the operation was performed, even if after 30 days; and (2) those deaths occurring after discharge from the hospital, but within 30 days of the procedure unless the cause of death is clearly unrelated to the operation.

If, several days postoperatively, a patient is transferred to a Rehab Hospital and eventually dies in the Rehab Hospital (having never gone home after the surgery), should this be coded as an operative death?  (Is it considered the same hospitalization because the patient never went home?)

The STS definition for operative mortality  includes all deaths occurring during the hospitalization in which the operation was performed even if after 30 days.  In the above case the death should be counted as an operative mortality if it occurred within the 30 day time frame.  If the patient was discharged to the Rehab and expired greater than 30 days this would not be considered an operative mortality. (4-19-02)

A patient was admitted for a hip replacement.  It was discovered that he had a MI.  The patient had CABG two days later.  14 days after CABG the patient had the hip replacement.  28 days later the patient expired.  The patient never left the hospital.  Is this an operative mortality?

The definition states “all deaths occurring during the hospitalization in which the operation was performed…”  Given this clinical scenario, Operative Mortality would be coded as “Yes” (3-25-02).

5360

Mort-Date

What was the date of death?

5370

Mort-Location

Specify the patient location at time of death:

Operating Room (OR).

Hospital (Other than Operating Room).

Home.

Other Care Facility.

What do we do if we know the patient died but do not know the place of death?  Should we leave it blank?  Can you add an unknown category to the list of options? 

If a patient died in an inhospital skilled care unit, should Other Care Facility or Hospital be marked?

If the location of death is unknown then leave it blank.  The STS can not add an unknown category at this time.  If the inhospital skilled care unit is comparable to a nursing home or rehabilitation or extended care facility and is not the typical “hospital unit” then Other Care Facility should be marked.

Hospitals are considered acute care centers.  Any institution providing long or short term care after a discharge from an acute care setting is considered an “other facility.”  If a patient is transferred from the primary procedure acute care setting to another acute care in hospital care setting, the selection should be “hospital” if death occurs within this location (3-25-02).

5380

Mort-Prim Cause

Specify the PRIMARY cause of death, i.e. the first significant abnormal event which ultimately led to death; choose one of the following:

Cardiac

Neurologic

Renal

Vascular

Infection

Pulmonary

Valvular

Other

What do we do if we know the patient died, but do not know the cause of death?  Do we leave it blank?  Can the STS add an “unknown” category to the list of options?

Leave it blank.  At this time the STS is not adding an “Unknown” category.  Every attempt should be made to obtain clear organ system cause of death.  When multiple organ system failure is involved, select the organ system that initiated the cascade of events that led to eventual death (3-25-02).

5500

Readmit <=30 Days from DOP

Patient was readmitted as an in-patient within 30 days from the date of surgery for ANY reason.

9/03

Definition states for “any” reason.  What about planned admissions for another surgical procedure? My gut feeling is that STS wants only Unplanned readmissions.

Any admission within 30 days, planned or unplanned, is coded.

5510

Readmit Reason

Primary reason the patient was readmitted as an in-patient within 30 days from the date of surgery (select one):

Anticoagulant Complication.

Arryhthmias/Heart Block/Pacemaker Insertion/AICD

Congestive Heart Failure (CHF).

Myocardial Infarction (MI) and/or Recurrent Angina.

Pericardial Effusion and/or Tamponade.

Pneumonia or other Respiratory Complication.

Valve Dysfunction.

Infection - Deep sternum

Infection - Leg

Cardiac catheterization

PTCA

Stent

Renal failure

TIA

Reop for Graft Occlusion

Reop for Bleeding

Permanent CVA

Acute Vascular Complication

Other Complication (e.g. hepatic, GI, etc).

5610

Predicted Risk of Mortality

Calculated from software.

5620

Predicted Deep Sternal Wound Infx

Calculated from software.

5630

Predicted Reoperation

Calculated from software.

5640

Predicted Permanent Stroke

Calculated from software.

5650

Predicted Prolonged Ventilation

Calculated from software.

5660

Predicted Renal Failure

Calculated from software.

5670

Predicted Morbidity or Mortality

Calculated from software.

5680

Predicted Short Length of Stay

Calculated from software.

5690

Predicted Long Length of Stay

Calculated from software.