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The Society of Thoracic Surgeons Frequently Asked Questions: Adult
Cardiac Surgery Database Version 2.52.1 August, 2006 How to use the interactive FAQ Document: 1. To
review all clinical questions in an individual section, click on the section
title below. |
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Section G:
seq# 890-1040 |
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2.
To review an individual Seq# clinical question, click on the Seq# title
below. 1280 OpCAB
3090-3180 Section R. 3. CC/TM: Corrections/Clarifications to Training
Manual |
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NEW |
Date |
SeqNo |
FieldName |
Definition |
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890 |
Meds-Beta Blockers |
Indicate whether the patient has received Beta Blockers within 24 hours
preceding surgery. |
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12/04 |
Can combination drugs such as Ziac (Beta-blocker + diuretic) be
included in these fields? |
Yes, you may include combination drugs. |
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900 |
Meds-ACE Inhibitors |
Indicate whether the patient has received ACE-inhibitors within 24
hours preceding surgery. |
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1/05 |
It
has recently come to the attention of the STS that as of January 2005, JCAHO
allows for ARBs to be captures as ACE Inhibitors. Based on this information, the STS has
decided that, effective 1. Prior to 2. On or after |
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CC/TM |
4/05 |
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Norvasc/Amlodipine
is listed in the training manual as an ACE. Norvasc/Amlodipine is a Calcium
Channel Blocker. Will remove from the ACE Inhibitor list in the Traning
Manual. Lotrel
is a combination drug with both Calcium Channel Blocker and Ace Inhibitor
properties. Please code all categories that apply. In the case of Lotrel,
code Seq# 900 ACEI=Yes; Calcium Channel Blocker is not collected in the core
elements. |
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910 |
Meds-Nitrates-I.V. |
Indicate whether the patient received I.V. Nitrates within 24 hours
preceding surgery. |
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930 |
Meds-Anticoagulants |
Indicate whether the patient received IV and/or subQ Anticoagulants
within 48 hours preceding surgery. Do
not capture Coumadin here. |
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CC/TM |
8/04 |
The definition for seq# 930 Meds-Anticoagulants clearly states that Coumadin should not be
captured under seq# 930. Coumadin
should only be captured under seq# 950, Coumadin. Under seq# 930, the Training Manual
correctly list Coumadin as an Anticoagulant.
Having Coumadin listed in the Training Manual under seq# 930 has
confused some Data Managers. Please
only capture Coumadin under seq# 950.
Do not capture Coumadin under seq# 930. |
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940 |
Meds-Anticoagulants-Medication Name |
Indicate the name of the IV and/or subQ
anticoagulant the patient received within 48 hours preceding surgery. |
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8/04 |
How should the medication Arixtra/ fondaparinux be coded? |
Please code as a Thrombin Inhibitor:
The antithrombotic activity of fondaparinux sodium is the result of
antithrombin III (ATIII)-mediated selective inhibition of factor Xa. By
selectively binding to ATIII, fondaparinux sodium potentiates (about 300
times) the innate neutralization of factor Xa by ATIII. Neutralization of
factor Xa interrupts the blood coagulation cascade and thus inhibits thrombin
formation and thrombus development. |
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8/04 |
Please clarify the drugs that would be classified as Thrombin
Inhibitors. |
Below is a list of the Thrombin Inhibitors that are listed in the
Training Manual and a few others. Your
pharmacist may be able to give you a more complete list. Agratroban: Agratroban Refludan: Lepirudin Angiomax: Bivalirudin Arixtra: Fondaparinux sodium |
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12/04 |
For patients that receive both Heparin-Unfractionated and Heparin-Low
Molecular within 24 hours of surgery.
Which one should I code or should I code both? |
Unfortunately, for seq# 940 you will only be able to code one; Heparin
(Unfractionated), Heparin (Low Molecular) or Thrombin Inhibitors as the Adult
Cardiac Surgery Database is a flat file database. In the next version of the Database, we
will consider changing seq# 940 into three separate fields to capture
patients that are taking one or more of these drugs at the same time. Feel free to customize fields to capture
patients that are taking more than one of these drugs at the same time. |
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950 |
Meds-Coumadin |
Indicate whether the patient received
Coumadin within 24 hours preceding surgery. |
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4/04 |
Preoperative Coumadin, given within
24 hours of surgery, is to be captured under seq# 950, Meds-Coumadin. Preoperative Coumadin is never to be
captured under seq# 930, Meds-Anticoagulants. |
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970 |
Meds-Inotropes |
Indicate whether the patient received IV Inotropic Agents within 48
hours preceding surgery? |
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4/05 |
One
of our surgeons was at the recent Western Thoracic Society Mtg and reported
that Natrecor is being coded as a preop inotrope at some hospitals since it
resembles Milrinone. Is it correct to code Natrecor as a preop inotrope?
Perhaps should put in FAQ as this is "new" drug and it seems there
is probable inconsistency in it's coding. |
Milrinone
is an inotrope. It's primary mechanism of action is to improve hemodynamics
and biventricular function in patients with ventricular dysfuntion by
increaseing stroke volume index, increasing left ventricular contractility.
It produces both positive inotropic effects and vasodilation independent of ß1-adrenergic
receptor stimulation in the cardiovascular system. Milrinone also produces
vasodilation in arteriolar and venous vascular smooth muscle. Yes,
please capture Milrinone as Seq# 970 MedInotr=Yes. The Section Intent for
Section G in the Training Manual states, "...This list includes the more
common cateogry drugs, but is not meant to be an all inclusive list."
The list was as complete as possible at the time of the Training Manual
development back in 2003. Will add Milrinone to the list for the next data
specification upgrade and to the FAQ. Natrecor
is a vasodilator. Vasodilitation of arteries and veins to decrease the
workload of the heart. Although it has similar vasodilitory actions to
Milrinone, it is not categorized as an Inotrope. |
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980 |
Meds-Steroids |
Indicate whether the patient was taking
steroids within 24 hours of surgery.
This does not include a one time dose related to prophylaxis therapy
(i.e. IV dye exposure for cath procedure or surgery pre-induction period). Non-systemic medications are not included
in this category (i.e. nasal sprays, topical creams). |
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CC/TM |
2/04 |
In
the training manual for seq# 980, the drug Norvir/Ritonavir is listed as a
steroid. This drug is actually a
protease inhibitor and should not be included in the steroid list.. |
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990 |
Meds-Aspirin |
Indicate whether the patient received Aspirin or Ecotrin within 5 days
preceding surgery? |
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1000 |
Meds-Lipid Lowering |
Indicate whether the patient received Lipid Lowering medication within
24 hours preceding surgery. |
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1/05 |
Would herbal supplements, such as
flaxseed oil, qualify as a lipid lowering medication? Documentation states that the use of
flaxseed oil resulted in the lowering of patients cholesterol. |
No. Please do not to capture
flaxseed oil as a lipid lowering medication. |
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1010 |
Meds-Lipid Lowering-Medication Name |
Indicate the type of Lipid Lowering mediation the patient received
within 24 hours preceding surgery. |
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6/04 |
Some patients simultaneously take statins and non-statins. When coding this field does one choice take
precedence over the other? |
No, one does not take precedence over the other. Unfortunately, you will only be able to
code either statin or non-statin. The
option of choosing both will be considered in the next specification
upgrade. |
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1020 |
Meds-ADP Inhibitors |
Indicate
whether the patient has received ADP Inhibitors within 24 hours preceding
surgery. |
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11/04 |
ADP stands for Adenosine Diphosphate. See Training Manual for additional
information on ADP Inhibitors. The following drugs should
be captured as ADP Inhibitors: Plavix or Clorpidogrel Ticlid or Ticlodipine Pletal or Cilostazol The following drugs should not
be captured as ADP Inhibitors: Persantine or Dipyridimole Aggrenox (aspirin + extended release Dipyridimole) |
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4/05 |
Can you explain why plavix is only coded as yes if it is
within 24 hours? Plavix's half life is much longer and has significant effect
on perioperative bleeding and blood utilization? Even STS recommendations are
to stop 5 days preop. ASA is coded yes for a 5 day time frame and is not
nearly as disruptive to periop coagulation. Should aggrenox be coded as ASA?
Combo drugs are not listed in that section. |
At the time Plavix was added to the data set as a
preoperative medication, the 24 hour window was applicable with the dosing
and administration at that time. Because of the evolution in usage of Plavix,
the 24 hour window does not make sense. Will change for the next spec
upgrade. |
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1030 |
Meds-Glycoprotein IIbIIIa Inhibitor |
Indicate whether the patient received
Glycoprotein IIb/IIIa inhibitors within 24 hours preceding surgery. |
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1040 |
Meds-Glycoprotein IIbIIIa Inhibitor-Medication Name |
Indicate the name of the Glycoprotein
IIb/IIIa Inhibitor the patient received within 24 hours preceding surgery. |
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From version 2.41 |
5/03 |
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Section H Hemodynamics and Cath |
In
the past, the STS has stated that using intra-op
TEE results to code fields in Section H, Hemodynamics and Cath, was
appropriate. After reviewing this
statement the STS has decided that intra-op
TEE results should not be used to code this section. Only procedure results obtained pre-op should be used to code this
section. Please
note that it is not necessary to go back and change data that has been
affected by this definition clarification.
However, moving forward please obtain data based on the clarification
information given above. |
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