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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 Q:
seq# 3020-3080 |
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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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3020 |
Mort-Mortality |
Indicate whether the patient has been
declared dead. |
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From version 2.41 |
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. |
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3030 |
Mort-DC Status |
Indicate whether the patient was alive
or dead at discharge from the hospitalization in which surgery occurred. |
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3040 |
Mort-30d Status |
Indicate whether the patient was alive
or dead at 30 days post surgery (whether in hospital or not). |
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3050 |
Mort-Op Death |
Indicate whether the patient had an
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. |
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From version 2.41 |
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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 |
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From version 2.41 |
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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. |
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4/04 |
A patient was transferred after surgery from our acute care hospital
(Hosp A) to another acute care hospital (Hosp B) (for higher level of renal
care) and ultimately died over 30 days beyond the procedure. The patient
never left Hospital B. Is this considered an operative mortality for
Hospital A? |
No, this is not considered an operative mortality because
for the purposes of the STS, even though the patient went to a similar level
of care (acute), it is still considered a discharge from Hospital A. Therefore, the patient was discharged from
the hospital in which the operation was performed and died outside of the 30
day window = no, op mortality. If the
patient died within 30 days = yes, op mortality. |
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4/04 |
Patient is discharged from acute care hospital after cardiac surgery
to skilled nursing care unit of the hospital. Patient is readmitted to
hospital and dies within 30 days of procedure. Is this an operative
mortality? |
Yes, this is considered an operative mortality because
even though the patient was discharged from the hospital in which the
operation was performed, the death occurred within the 30 days. |
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4/04 |
Is this an operative mortality if the patient is readmitted to acute
care hospital from skilled nursing unit and dies 30 days beyond the
procedure? |
No, this is not considered an operative mortality because
the patient was discharged from the hospital in which the operation was
performed and the death occurred outside the 30 day window. |
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4/04 |
At the November 2004 Data Managers Meeting someone mentioned a paid social security death index that can be used
to check for 30 day mortalities. Do
you have information on that index? |
-Front page, right hand column, "Search Engines and
Databases." -Third title down, "Social Security Death Index." Please remember it sometimes takes months before a death gets listed,
so to check within 30 days of when a procedure was done will be of little
use. Sites that use this option
usually check every 6 months to update their records. 2. Depending upon the wealth of the
site, you can purchase a license for access to the National SSI which
provides weekly, monthly, quarterly or annual updates depending upon the
level of subscription. The fees vary
depending upon the level (range is $7500.00 for weekly and $3450.00 for
quarterly or $2500.00 monthly). If
sites are doing frequent studies where the end point is death, then this
option may be well worth the price.
National Technical Information Service (NTIS) 1-800-363-2068 or
703-605-6060. |
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CC/TM |
6/04 |
The Field Clarification section of the Training Manual,
for seq# 3050, Mort-Op Death, should read
in its entirely, If a death occurs outside of the
hospital but within 30 days, it is considered surgically related unless it is
clearly unrelated to the operative procedure.
Example of a non Operative Mortality is if the death was the
result of an accident/trauma or cancer.
Thus removing the words
or cardiovascular in nature as this
language is confusing and contradictory. |
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1/05 |
We have a controversy at our institution regarding the proper way to
code operative mortality with DNR patients.
Example #1: Two patients had
renal consults pre-op due to elevated creatinine and both developed post-op
renal failure requiring dialysis. In
both cases the patients were moving along in their progress but decided they
did not want to continue dialysis and initiated DNR requests. Neither patient left the hospital and both
expired within 30 days of the surgical procedure Example #2: Pt is readmitted on
postoperative day # 7 with a diagnosis that plausibly could be related to the
CABG procedure, but is certainly a treatable condition (e.g.-cholecystitis,
UTI, pneumonia, etc.). The family,
however, says, "Dad has had a good life...we refuse to let you treat him."
DNR status is initiated and the patient expires one week later. Are these examples considered operative mortalities? While the postoperative diagnoses are
probably related to the CABG event, the ultimate "cause of death"
is the patients or family's refusal to treat. Please know that I have received these types of scenarios before and
have consistently provided the same answer.
All of these cases should be coded as yes to operative
mortality. Irregardless of the DNR
status, the patients expired within 30 days of the procedure and the cause of
death is not clearly unrelated to the surgery. |
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3060 |
Mort-Date |
Indicate the date the patient was
diagnosed clinically dead. |
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3070 |
Mort-Location |
Indicate the patient's location at time
of death: Operating
Room (OR) during initial surgery Hospital
(Other than Operating Room) Home Other
Care Facility Operating
Room (OR) during reoperation |
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CC/TM |
2/04 |
In the Data Field Intent section of the Training Manual, for seq#
3070, Mort-Location, definition for Operating
Room should read in its entirety, Did the patient die in the operating room
at the time of the primary surgical procedure. Thus removing the words,
or subsequent
re-operative procedure as these cases would be covered in the OR During
Reoperation category. |
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3080 |
Mort-Prim Cause |
Indicate 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 Unknown Other |
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