Section I

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.
Section A: seq# 40-80				Section F: seq# 750-870		Section K: seq# 1630-1880			Section P: seq# 2710-3010
Section B: seq# 100-210				Section G: seq# 890-1040		Section L: seq# 1920-2350			Section Q: seq# 3020-3080
Section C: seq# 220-340				Section H: seq# 1050-1200		Section M: seq# 2360-2560			Section R: seq# 3090-3210
Section D: seq# 350-550				Section I: seq# 1210-1500		Section N: seq# 2570-2600			Section S: seq# 3220-3240
Section E: seq# 560-670				Section J: seq# 1520-1620		Section O: seq# 2610-2700
2. To review an individual Seq# clinical question, click on the Seq# title below. 310 ICUInHrs 2470 OCarAFib 340 TotHrICU 2560 OCarOthr 440 RenFail 2710 Complics 490 InfEndo 2750 COpReOth 850 ArrhyTyp 2780 CISternDeep 1050 NumDisV 2830 CNStrokP 1260 EmergRsn 2950 COtCoag 1280 OpCAB 3090-3180 Section R. 1310 OpOCard 3220 Readm30 1380 PerfusTm 3240 ReadmPro 1410 XClampTm 1640 OpMitral 1650 OpTricus 3. CC/TM: Corrections/Clarifications to Training Manual
NEW	Date	SeqNo	FieldName		Definition
		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.
		1220	Surgeon ID		Indicate the unique identification number assigned to the surgeon by the participant.
	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.
		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 (USA) with intravenous (IV) nitroglycerin (NTG) or rest angina may be included. 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.
	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.
		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 (USA) with intravenous (IV) nitroglycerin (NTG). Rest angina. Valve Dysfunction Aortic Dissection Angiographic Accident
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.
		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
From version 2.41					Choices include Shock with circulatory support and Shock without circulatory support. Please define Circulatory support.		Circulatory support was defined by ACC, STS and Dr. Robert Jones' short-term outcomes recording paper as: Shockplease see definition of shock in patient history circulatory support: IABP and/or IV inotrope to maintain DPB or CO. (3-25-02)
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.
NEW!	08/06				Short Field Name: EmergRsn Message: Valve Dysfunction: Would this element be selected only if the patient has previously had a mechanical valve? In my paticular case the patient had a MI experinced severe mitral regurgitation and had a flail mitral leaflet and went emergently to the OR for CABG and Mitral valve reconstruction with annuloplasty. Patient had an acute rupture of posterior cordae.		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.
		1270	Robotic Technology Assisted		Indicate whether the cardiac surgery was assisted by robotic technology.
		1280	CAB		Indicate whether coronary artery bypass grafting was done?
NEW!	08/06				Other Cardiac Procedures Message: If the surgeon is just placing epicardial leads for future arrhythmia devices (device itself not placed at time of initial surgery), should this be captured somewhere such as in the 'other' category or not?			Code this case as Isolated CAB or Isolated Valve
		1290	Valve		Indicate whether a surgical procedure was done on the Aortic, Mitral, Tricuspid or Pulmonic valves.
		1300	VAD		Indicate whether a ventricular assist device (VAD) was used.
	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.
		1310	Other Card		Indicate whether another cardiac procedure was done (other than CABG and/or Valve procedures).
	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.
	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.
*NEW!*	08/06				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.
*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.
*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.
*NEW!*	08/06				Cardiac other Message: In addition to CABG, the patient had "ligation of fistula between LAD and PA". Should this be listed as "Cardiac Other" or ignored and just an antecdotal note to myself. Thanks.			Isolated CAB
		1320	Other Non Card		Indicate whether a non-cardiac procedure was done.
		1330	Skin Incision Start Time		Indicate to the nearest minute (using 24 hour clock) the time the skin incision was made.
	12/04				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.
		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.
		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
	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.).
	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.
	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.			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.
		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.
		1370	CPB Utilization Unplanned Combination Reason		Indicate the reason that the procedure required the initiation of CPB and/or coronary perfusion.
		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.
From version 2.41	7/03				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.
	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.
	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.
NEW!	08/06				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.
		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.
		1400	Aortic Occlusion		Indicate the type of aortic occlusion used. Indicate the highest level of occlusion.
	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.
		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.
NEW!	08/06				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.
		1420	Cardioplegia		Indicate whether cardioplegia was used.
		1430	IABP		Indicate whether the patient was placed on Intra-Aortic Balloon Pump (IABP).
		1440	IABP-When Inserted		Indicate the time of earliest IABP insertion? Choose one of the following: Preoperatively. Intraoperatively. Postoperatively.
		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.
		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.
	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.
	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.
		1470	Intraop Blood Products RBC Units		Indicate the number of units of Red Blood Cells that were transfused intraoperatively.
		1480	Intraop Blood Products FFP Units		Indicate the number of units of Fresh Frozen Plasma that were transfused intraoperatively.
		1490	Intraop Blood Products Cryo Units		Indicate the number of units of Cryoprecipitate that were transfused intraoperatively.
		1500	Intraop Blood Products Platelet Units		Indicate the number of units of Platelets that were transfused intraoperatively.
	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.