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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 I:
seq# 1210-1500 |
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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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1210 |
Surgeon |
Indicate the surgeon's name. This field must have controlled data entry
where a user selects the surgeon name from a user list. This will remove
variation in spelling, abbreviations and punctuation within the field. Note:
Surgeon name is encrypted in the analysis database. Punctuation,
abbreviations and spacing differences can not be corrected at the warehouse. |
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1220 |
Surgeon ID |
Indicate the unique identification
number assigned to the surgeon by the participant. |
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7/04 |
We don't have physician ID numbers at our practice. Is the information
necessary to code this field provided by the STS or by each individual
site? |
This number is not assigned by the STS and if your site does not have
or use such ID numbers, leave the field blank. This field is an optionally harvested field
as indicated in the data specifications.
This means that each site determines how they would like to use the
field. You can ignore the field all
together, fill in the field and not harvest the information to DCRI or fill
in the information and send the information to DCRI. Completely up to you. |
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1240 |
Status |
Indicate the status that best describes the clinical status of the
patient at the time of surgery Emergent Salvage: Definition: The patient is undergoing CPR en route to the OR or prior
to anesthesia induction. Emergent: Definition: The patients clinical status includes any of the
following: a. Ischemic dysfunction (any of the following): (1) Ongoing ischemia
including rest angina despite maximal medical therapy (medical and/or IABP));
(2) Acute Evolving Myocardial Infarction within 24 hours before surgery; or
(3) pulmonary edema requiring intubation. b.. Mechanical dysfunction (either of the following): (1) shock with
circulatory support; or (2) shock without circulatory support. Urgent: Definition: ALL of the following conditions are met: a. Not elective status. b. Not emergent status. c. Procedure required during same hospitalization in order to minimize
chance of further clinical deterioration. d. Worsening, sudden chest pain, CHF, acute myocardial infarction
(AMI), anatomy, IABP, unstable angina ( Elective: Definition: The patients
cardiac function has been stable in the days or weeks prior to the
operation. The procedure could be
deferred without increased risk of compromised cardiac outcome. |
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03/06 |
Can a patient be considered
elective status for heart transplant? It seems that any patient requiring
heart transplant should be at minimum, urgent, considering that harvesting
the heart has to be done in a limited time frame. |
Yes, a transplant patient can be
coded as elective. The patient may be stable enough on therapy at home while
waiting for a donor heart. If the patient requires hospitalization for
hemodynamic and/or inotropic support while waiting for a donor heart, the
status would be urgent or emergent depending on the individual clinical
scenario. |
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1250 |
Urgent Reason |
Delay in the operation is necessitated only by attempts to improve the
patient's condition, availability of a spouse or parent for informed consent,
availability of blood products, or the availability of results of essential
laboratory procedures or tests. Indicate which one of the following applies as the reason why the
patient had Urgent Status? (Select one) Acute myocardial infarction (AMI). IntraAortic Balloon Pump (IABP). Worsening, sudden chest pain. Congestive Heart Failure (CHF). Coronary Anatomy. Unstable angina ( Rest angina. Valve Dysfunction Aortic Dissection Angiographic Accident |
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From version 2.41 |
5/03 |
Please
define valve disfunction in regards to urgent status. |
Valve
dysfunction is typically associated with mechanical valves and is defined as
a structural failure with that mechanical valve fractured leaflet, thrombus
formation, panus development which impedes flow through the valve
orifice. If any of these situations
occur a patients clinical status is often compromised and the degree of
compromise will determine the status urgent, emergent, or emergent salvage. |
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1260 |
Emergent Reason |
Patients requiring emergency operations will have ongoing, refractory
(difficult, complicated, and/or unmanageable) unrelenting cardiac compromise,
with or without hemodynamic instability, and not responsive to any form of
therapy except cardiac surgery. An
emergency operation is one in which there should be no delay in providing
operative intervention. Indicate which one of the following applies as the reason why the
patient had Emergent Status? (Select one): Shock with circulatory support. Shock without circulatory support. Pulmonary edema requiring intubation. Acute Evolving Myocardial Infarction within 24 hours before surgery. Ongoing ischemia including rest angina despite maximal medical therapy
(medical and/or IABP). Valve Dysfunction Aortic Dissection Angiographic Accident |
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From version 2.41 |
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Choices include Shock with circulatory
support and Shock without circulatory support. Please define Circulatory support. |
Circulatory support was defined by ACC, |
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From version 2.41 |
5/03 |
Please
define valve dysfunction in regards to emergent status. |
Valve
dysfunction is typically associated with mechanical valves and is defined as
a structural failure with that mechanical valve fractured leaflet, thrombus
formation, panus development which impedes flow through the valve
orifice. If any of these situations
occur a patients clinical status is often compromised and the degree of
compromise will determine the status urgent, emergent, or emergent salvage. |
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NEW! |
Short Field Name: EmergRsn |
The Emergent Reason for this case
would be AEMI if the surgery was performed within 24 hours of the MI. If however, the surgery was longer than 24
hours after the MI the emergent reason would be Ongoing Ischemia. |
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1270 |
Robotic Technology Assisted |
Indicate whether the cardiac surgery
was assisted by robotic technology. |
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1280 |
CAB |
Indicate whether coronary artery bypass grafting was done? |
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NEW! |
Other Cardiac Procedures |
Code this case as Isolated CAB or
Isolated Valve |
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1290 |
Valve |
Indicate whether a surgical procedure
was done on the Aortic, Mitral, Tricuspid or Pulmonic valves. |
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1300 |
VAD |
Indicate whether a ventricular assist
device (VAD) was used. |
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01/06 |
If, during a CABG, a patient can't come off
pump and needs a VAD, is that classified as CABG or Other? |
This would be coded as Seq# 1280
OpCAB=Yes and Seq# 1300 VAD=Yes. This case would be categorized as a
CAB+Other according to the v2.52.1 Procedure Identification Table. |
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1310 |
Other Card |
Indicate whether another cardiac
procedure was done (other than CABG and/or Valve procedures). |
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10/05 |
Does a chronic A-Fib patient who had a resection of left
atrial appendage during their CABG fit the definition of CABG + Other Cardiac
- Other ? |
No. Resection of Left Atrial Appendage does not qualify as
an Other Cardiac Procedure. CABG w/ Resection Left Atrial Appendage would be
coded as an Isolated CABG. |
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01/06 |
Operative procedure is Off pump
CABGX3, Exclusion of the left atrial appendage, and cardioversion. Should this be entered as CABG only or CABG
and other cardiac procedure? |
This would be an Isolated CABG. |
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NEW! |
If a surgeon has to do a local dissected
aneurysm repair to the aorta that was due to operative manipulations during
an isolated CAB that didn't involve a full aortic graft, (just suture repair
and reattachment of proximal graft) does this throw it into "cardiac
other" in addition to the CAB? I
don't think so but wanted to clarify.
It happened at a vein hood attachment that kept getting worse with
attempted repair at the site. |
No, this is isolated CAB. |
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NEW! |
08/06 |
The auditors are presently at our
hospital and auditing 20 Isolated CAB charts for STS. A question came up regarding the
"other" operative category.
Can we mark a CAB with a vein patch angioplasty of the LAD as CAB with
other cardiac procedure or is it an isolated CAB? Can we mark a CAB with a
retrosternal lymph node biopsy as a CAB with other procedure or is it an
isolated CAB? |
Vein patch is not CAB + other. Retrosernal lymph node biopsy is not CAB +
other. These cases would be excluded
from the risk stratificatin models. It
is important to include all appropriate isolated CAB. |
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NEW! |
08/06 |
If a patient had an endarterectomy of rca
exclusion of lad aneurysm patch plasties and bipass, how do I enter this? |
Coronary endarterectomy does not
change the operative category from isolated CAB, nor does patch angioplasty. |
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NEW! |
08/06 |
Cardiac other |
Isolated CAB |
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1320 |
Other Non Card |
Indicate whether a non-cardiac
procedure was done. |
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1330 |
Skin Incision Start Time |
Indicate to the nearest minute (using
24 hour clock) the time the skin incision was made. |
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12/04 |
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Skin Incision Start Time: does this only apply to the start time of
the chest/thoracotomy incision? At our
institution the skin incision start time begins with the incision to harvest
the leg vein, not the time of the chest incision. Is this correct? |
The intent of this field is to capture the time the first skin
incision is made irregardless of if the first incision is a harvest site
incision or a sternal/thoracotomy incision. |
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1340 |
Skin Incision Stop Time |
Indicate to the nearest minute (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. |
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1350 |
CPB Utilization |
Indicate the level of CPB or coronary
perfusion used during the procedure: None =
no CPB or coronary perfusion used during the procedure Combination
= with or without CPB and/or with or without coronary perfusion at any time
during the procedure At
start of procedure: No CPB/No Coronary
Perfusion -> conversion to ->
CPB At
start of procedure: No CPB/No Coronary
Perfusion -> conversion to -> Coronary perfusion At
start of procedure: No CPB/No Coronary
Perfusion -> conversion to -> Coronary perfusion -> conversion to
-> CPB Full =
CPB or coronary perfusion was used for the entire procedure |
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2/07 |
Coronary perfusion methods are used as an alternative to complete
heart and lung bypass. They are often
referred to perfusion assisted devices where just the coronary artery that is
being grafted is perfused (distal) to the anastomoses site (a method of
supplying distal perfusion to isolated coronary arteries while new grafts are
constructed). While not as invasive as
cardiopulmonary bypass it is still a method of supporting the myocardium
during a period of relative ischemia.
These devices allow for continued myocardial perfusion to the area of
myocardium that is being revascularized, therefore reducing any ischemic time
to that region. They also do not
expose the patient to the typical risks poised by the heart/lung system (i.e.
microembolism, heparinization, fluid imbalances, cellular damage etc.). |
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7/04 |
What is the correct way to code a patient who has Left Heart Assist
(LAFA), not CPB? |
In version 2.41 it was determined to include all methods of perfusion
(either cardiopulmonary or coronary alone) as full CPB because of their
hemodynamic-myocardial protection.
Therefore, in version 2.52, code CPB as "Full" (assuming
that Left Heart Assist (LHA) was used for the entire case) or
"Combination" (if the case was started as an off pump case (OPCAB)
and then moved to LHA). Seq# 1360
would be coded accordingly as either planned or unplanned. |
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01/06 |
How does STS define OFF PUMP procedures? Do
they consider them as NO bypass(none) or as PARTIAL bypass (combination)?
There are 3 categories: none, full,
and combination. In order to classify
between on/off pump I need to know exactly how to differentiate between them.
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Off Pump procedures are defined as
Seq# 1350 CPBUtil = None. Seq# 1350 is the parent field to Se# 1380 PerfusTm.
Seq# 1350 has to be coded as Combination or Full to be able to enter a value
in #1380. |
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1360 |
CPB Utilization Combination Plan |
Indicate whether the combination
procedure was a planned or an unplanned conversion. Planned
= the surgeon intended to treat with any of the combination options described
in"CPB utilization" Unplanned
= the surgeon did not intend to treat with any of the combination options
described in CPB utilization. |
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1370 |
CPB Utilization Unplanned Combination Reason |
Indicate the reason that the procedure
required the initiation of CPB and/or coronary perfusion. |
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1380 |
Perfusion time (min) |
Indicate the perfusion time in
minutes. Perfusion time is defined as
an accumulated total of CPB and/or coronary perfusion assist minutes. |
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From version 2.41 |
7/03 |
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Only
record the perfusion time for the first surgery. |
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1/05 |
Do we include the number of circulatory arrest minutes in the total
perfusion time? |
Yes, include the circ-arrest time in the total perfusion time. CPB initiated to begin a procedure that is
interrupted for circ-arrest and then resumed would be one total time in the
perfusion world. The arrest time would
be isolated only to note the ischemic time but not to differentiate it from
perfusion time. |
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1/05 |
Do we include selective antegrade perfusion minutes as part of the
perfusion time? |
If the patient has isolated coronary perfusion catheters in place,
then "yes" include in perfusion time. |
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NEW! |
I had a patient who left the OR on full
bypass to go to the cath lab for emergency cath and angioplasty, then
returned to the OR for coming off bypass.
Please help, how would I code this pt regarding reop complications, do
I use the first incision dress as the skin stop time, is there a place to
address post op angioplasty. I realize
this is different, but the team did an excellent job and pt was discharge
alive. Also is entire time noted for perfusion and cross clamp? thanks |
This patient has an intervention
which will be included in his operating time.
Skin incision is counted from the time knife is to skin until the
final dressings are applied. In this
case the patients trip to the cath lab just extends the operative time. Perfusion time is counted from the time
your patient goes on pump until he comes off which in this case will include
the time the patient is in the cath lab. The cross clamp would not be on
during the cath. |
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1390 |
Cannulation Method |
Indicate the method of cannulation used
for cardiopulmonary bypass (select one): Aorta
and Femoral/Jugular Vein. Femoral
Artery and Femoral/Jugular Vein. Aorta
and Atrial/Caval. Femoral
Artery and Atrial/Caval. Other. |
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1400 |
Aortic Occlusion |
Indicate the type of aortic occlusion
used. Indicate the highest level of
occlusion. |
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3/06 |
I have records in which the aorta
was not cross clamped. Should these
fields be left blank or time recorded as "0"? |
Seq# 1400 Aortic Occlusion would be
coded as None so Seq# 1410 XClampTm would be left blank. |
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1410 |
Cross Clamp Time (min) |
Indicate the total number of minutes
the aorta is completely cross-clamped during bypass. Minutes should not be
recorded if partial cross clamp is the highest level of occlusion. |
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NEW! |
Partial Crossclamp- when should
this be used? Does it apply when a partial cross-clamp is used for off-pump
CABG. |
Indicate the highest level of
occlusion. If the partial clamp is
used in an off pump procedure then code partial clamp. |
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1420 |
Cardioplegia |
Indicate whether cardioplegia was used. |
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1430 |
IABP |
Indicate whether the patient was placed
on Intra-Aortic Balloon Pump (IABP). |
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1440 |
IABP-When Inserted |
Indicate the time of earliest IABP
insertion? Choose one of the following: Preoperatively. Intraoperatively. Postoperatively. |
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1450 |
IABP-Indication |
Indicate the PRIMARY reason for
inserting the IABP? Choose one of the following: Hemodynamic
Instability. PTCA
Support. Unstable
Angina. Cardiopulmonary
bypass (CPB) weaning failure. Prophylactic. |
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1460 |
Intraop Blood Products |
Indicate whether blood products were
transfused any time intraoperatively during the initial surgery. Intraoperatively is defined as any blood
started inside of the OR. |
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3/04 |
Please note: for
the Intraop Blood Products field the intent is to ONLY collect blood products that were transfused any time intraoperatively
during the INITIAL SURGERY. Refer to seq# 2610 for the collection of blood
products transfused at any other time. |
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4/04 |
Does autologous blood count when coding this field? |
Do not count pre-donated (autologous) blood, cell saver,
pump residual and/or chest tube recirculated blood. |
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1470 |
Intraop Blood Products RBC Units |
Indicate the number of units of Red
Blood Cells that were transfused intraoperatively. |
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1480 |
Intraop Blood Products FFP Units |
Indicate the number of units of Fresh
Frozen Plasma that were transfused intraoperatively. |
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1490 |
Intraop Blood Products Cryo Units |
Indicate the number of units of
Cryoprecipitate that were transfused intraoperatively. |
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1500 |
Intraop Blood Products Platelet Units |
Indicate the number of units of
Platelets that were transfused intraoperatively. |
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6/04 |
It is imperative that each site
understand their institutions definition for Random Donor Platelets (RDP)
and Single Donor Platelets (SDP) when coding seq# 1500, Intraop Blood
Products Platelet Unit and seq# 2650, Blood Products - Platelet Units. Because
of platelet unit definition variation between institutions, A ten pack of
platelets = 10 units, not one unit is no longer applicable. Following is a guideline for assessing platelet utilization across multiple
medical centers. RDP:
count the dose pack as one unit.
A dose pack may consist of 4, 6, 8, 10 or any number of donor
platelets obtained from random donors. The number of units coded is not
volume dependant. SDP or Plateletpharesis: count as one unit. One unit is compromised of platelets
derived from a single donor. The
number of units coded is not volume dependant. |
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