The Society of Thoracic Surgeons

Frequently Asked Questions: General Thoracic Database

Version 2.07

 October, 2006

How to use the “interactive” FAQ Document:

1.  To review all clinical questions in an individual section, click on the section title below.

2.      To review an individual Seq# clinical question, click on the Seq# title below.

Participation in both General Thoracic and Adult Cardiac Databases

GENERAL STATEMENT #2

Seq# 200:   Zubrod Score                                                       Seq# 775:  Postop Events

Seq# 300:   WtLoss3Kg                                                           Seq# 860: Pneumonia

Seq# 310:  Category of disease                                              Seq# 930:  Other Pumonary Event

Seq# 390:  PreOp Chemotherapy                                           Seq# 940:  Atrial Arryhthmia

Seq# 400:  PreOp Thoracic RT                                               Seq# 1020:  Anastomotic leak

Seq# 430:  Other Cormorbidity                                              Seq# 1190:  Empyema

Seq# 540:  Clinical Stage Not Applicable (2.06)                  Seq# 1200:  Other event req. Rx

Seq# 725:  Reoperation                                                          Seq# 1250:  30 Day Status

Seq# 740:  Procedure                                                             Seq# 1280:  Chest Tube Out Date

Seq# 750:  Primary Procedure                   

Seq# 751:  Thoracoscopy Approach

NEW

Date

SeqNo

FieldName

Definition

280

Height in centimeters

Indicate the height of the patient in centimeters.

285

Height in inches

Indicate the height of the patient in inches.

290

Weight in kilograms

Indicate the weight of the patient in kilograms.

295

Weight in pounds

Indicate the weight of the patient in pounds.

300

Weight loss in the three months

Indicate by the number of kilograms lost, whether the patient has experienced any  weight loss in the last three months.  Enter “0” if answer is “none”.

3/06

"If the patient has unintentional weight loss of 10 lbs in 2 months, that is more relevant," how can we indicate that if the data specs say 3 months? Most of our patients who have weight loss, it is relative. Most of the time it is not with 3 months. Is there anyway to have a field "weight loss" and an added field of "weight loss duration?"

The intent is to capture unintended weight loss. The response initially sent was illustrating that losing 10 pound over 2 months is more relevant that losing 10 pounds over 2 years. The response also states: "...intent with this seq# is to capture a weight loss over the last three months." as indicated in the data specs.

310

Category of disease

Indicate to which disease category the patient’s primary disease process belongs.  Indicate the disease category if known preoperatively, if unknown preoperatively, may enter postoperatively.

4/04

When I have a patient with metastasis to the lung from another type of cancer (i.e. renal cell), do I code this as: 

1.        Metastasis – Lung

or

2.        Metastasis – Other

Does “metastasis – lung” mean to the lung or another spot/spread from the lung cancer?

Metastasis – lung = a metastasis to the lung from any type of cancer

Metastasis – other = metastasis from lung cancer, esophageal or other type of cancer to areas in the thorax outside of the lung—mediastinum, chest wall, etc.

4/04

Which category of disease should we place idiopathic, interstitial, or connective tissue disease?

Please code as Lung - Benign.

12/04

1.  Since we can only code one harvest code option for seq#310, what is the order of priority for categories if a patient has more than one disease process?

A.        Benign lung w/incidental (+) cultures found on final path 

2.  Does category of disease pertain only to the procedure performed?

B.        Patient has thoracic cancer but procedure is a tracheostomy for respiratory failure

The definition states “Indicate to which disease category the patient’s primary disease process belongs….”

Based on the definition, coding should be based on the primary disease process, which may not necessarily be the procedure being performed.  For your first example code Lung - Benign.  For your second example code Lung - Primary.

3/06

If a patient has a malignant pleural effusion of a non-thoracic primary and does not also have a thoracic tumor, how should we caputre this?

Code Seq# 310 Category = Metastatic-Other

3/06

This question applies to version 2.07.  Comorbitities have changed to Yes/No instead of choosing "none" or appropriate selection.  If comorbidities are unknown for whatever reason - not documented, unable to obtain, etc., should "unknown" be included as a choice?  

This would require adding a choice of Unknown to all comorbidity fields. Will consider for next spec upgrade. However, if the H&P that is in the patient's chart prior to surgery does not document the comorbidity, please code No. There should be a level of comfort in taking what is in the patient's chart as an accurate list of preop patient conditions. Another suggestion would be to talk with the docs re: specifically documenting yes/no to all of the comordities listed on the DCF, possibly a pre-printed H&P.

NEW!

10/06

Under category of disease, there is no category for diaphragm.  Under what category should they be captured? 

for current version under mediastinal; next update it's own category

NEW!

10/06

This is the STS definition of category of disease: Indicate to which disease category the patient’s primary disease process belongs. Indicate the disease category if known preoperatively, if unknown preoperatively, may enter postoperatively.
How do you account for pre-op diagnoses which are different than final diagnoses?  This is an area of ongoing interest to many thoracic surgeons.
For example: pre-op suspected malignancies which are, on final pathology, benign?  

Patients would be clinically staged for suspected lung or esophageal cancer.  Since they would have a benign pathology, there would be no pathological staging.  The opposite staging would be true for suspected benign with a final path of lung or esophageal cancer.  On cases other than lung or esophageal cancer, there is no way to account for discrepancies in pre- and post-op diagnoses in the current General Thoracic database.

NEW!

10/06

 If a patient had a lung cancer in 1993 and are post pnumonectomy, then developes a recurring bronchoplural fistula w/empyema gram neg. in 2005 and undergoes C/W resection w/flaps and repair of fistula X 2 Is the category of disease still a lung primary even though all procedures are a result of recurring infections? 

Yes, the Category remains Lung - Primary according to the current data definitions. 

NEW!

10/06

Primary Chest Wall - Is this only for tumor or does it include all chest wall categories?

All chest wall categories.

NEW!

10/06

Does a perforated esophagus from an attempted dilatation fit in the "Trauma" category? It appears that the trauma given as examples were more "traumatic", as in MVA or GSW.

No, it should be coded as "Esophagus-Benign".  The procedure is "Repair, Perforation of esophagus-Iatropgenic.

NEW!

10/06

Message: I need some help picking the category of disease in order to give you what you're looking for.  Example:
A patient has esophageal cancer and has an esophagectomy with gastric conduit.  Here the category of disease is clearly "esophagus-primary."  The patient comes back in due to an esophageal stricture requiring dilation.  There is no evidence of recurrent cancer.  Does the category of disease remain "esophagus-primary" or because the patient is coming in due to a benigh esophageal stricture, is the category of disease "esophagus-benign"?  Later the patient returns to have a port-a-cath removed because his chemo is complete (no evidence of cancer).  Is the category of disease esophagus-primary (portacath put in for chemo) or "other" as patient has no evidence of esophageal cancer at this point.  Thanks very much. 

Yes, the Category remains Esophagus - Primary according to the current data definitions "Indicate to which disease category the patient's primary disease process belongs." 

NEW!

10/06

Short Field Name: chest wall primary
  Message: Our surgeon performed a repair chest wall after a dehiscence of an access thoracotomy for spinal fusion surgery.  We captured this procedure in the Chest wall primary section. Is this correct, or do we just collect patients that have surgery for chest wall cancers? If it is just for tumors of the chest wall would it be captured under other or trauma?  Please advise.

The Category section is under Pre-Operative Risk Factors.  It should be coded as "Other" as there is no primary chest wall cancer.  The Procedure should be coded as "Other Chest Wall Repair".  Dehiscence should be captured as a "Complication" on the first OR data collection form.  This Re-Op requires a new data collection form.

320

Lung Infection Type

Indicate the type of lung or pleural infection.

12/04

Should mediastinal infections be included under seq# 320, “Lung Infection Type?”

The definition limits the infections sites to the lungs and pleural.  Therefore, mediastinal infection would not be captured via seq# 320 or anywhere in the General Thoracic Surgery Database.

322

Trauma Requiring OR Intervention

Indicate whether a recent trauma resulted in a primary diagnosis that required OR intervention during this hospitalization.

325

Trauma Type

Indicate the type of trauma that resulted in a primary diagnosis that required OR intervention during this hospitalization.

330

No comorbidities

Indicate if the patient has NO comorbid factors.  If this value is Yes, then no other co-morbidities can be selected.

NEW!

10/06

 Are COPD and emphasema to be captured as comorbidities under "Other"?

Yes. 

340

Hypertension

Indicate whether the patient has a diagnosis of hypertension, documented by one of the following:

                   1. Documented history of hypertension diagnosed and treated with medication, diet

                      and/or exercise

                   2. Blood pressure >140 systolic or >90 diastolic on at least 2 occasions.

350

Steroids

Indicate whether the patient was taking steroids within 24 hours of surgery and 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).

360

Congestive heart failure

Indicate whether, within 2 weeks prior to the primary surgical procedure, a physician has diagnosed that the patient is currently in congestive heart failure (CHF). CHF can be diagnosed based on a careful history and physical exam, or by one of the following criteria:

                   1. Paroxysmal nocturnal dyspnea (PND)

                   2. Dyspnea on exertion (DOE) due to heart failure

                   3. Chest X-Ray (CXR) showing pulmonary congestion

                   4. Pedal edema or dyspnea and receiving diuretics or digoxin

370

Coronary artery disease

Indicate whether the patient has a history of coronary artery disease (CAD) as evidenced by one of the following:

                   1. Currently receiving medical treatment for CAD

                   2. History of Myocardial Infarction

                   3. Prior CV intervention including, but not limited to, CABG and/or PCI

380

Peripheral vascular disease

Indicate whether the patient has Peripheral Vascular Disease, as indicated by claudication either with exertion or rest; amputation for arterial insufficiency; aorto-iliac occlusive disease reconstruction; peripheral vascular bypass surgery, angioplasty, or stent; documented AAA, AAA repair, or stent; positive non-invasive testing documented.  Does not include procedures such as vein stripping, carotid disease, or procedures originating above the diaphragm.

390

Preoperative chemotherapy

Indicate if the patient has received preoperative chemotherapy for any reason prior to  this operation.   May be included as a component of a chemotherapy radiation induction therapy.  This item should also be selected if the medical oncologist gave the patient chemotherapy prior to sending the patient for any surgical evaluation, if the intent of the medical oncologist was to "shrink the tumor" prior to surgical intervention.

3/06

I have a patient who has a category of disease Pleura-Neoplastic. Her primary was breast cancer. Is her pre-op chemo given for her breast cancer considered "same disease" or "unrelated"?  Is her breast cancer considered "the same primary disease process that is being treated during this hospitalization"? (since her breast primary is why she has a Pleura-Neoplastic diagnosis)

The patients breast cancer is considered Unrelated. The Pre-Op chemo was given for the breast cancer BEFORE the Pleural diasnosis.

395

Preoperative chemotherapy - When

Indicate whether the prior chemotherapy treatment was:  Harvest:    Yes

                   1 = received any time prior to this hospitalization to treat this occurrence or

                          any previous occurrence of the same primary disease process that is

                          being treated during this hospitalization

                   2 = received within 6 months of this hospitalization to treat an unrelated disease

                   3 = received more than 6 months prior to this hospitalization to treat an unrelated

                        disease.

NEW!

10/06

Short Field Name: Preoperative chemotherapy when
  Message: For the response "any time, same disease" are you looking to determine only if the pt got chemo related to the current occurrence of tumor?  I have a pt who had lung cancer L and R sides in 2004.  By her history, she had a resection on the left, not on the right as PET scan was apparently neg on right.  (not really sure why right sided tumor wasn't resected). Chemotherapy was given.  Now she returns in 2005 with an enlarging right-sided mass (turns out to be same type lung cancer as previously) which is resected.  No chemoRx given prior to current resection.  Would her chemo in 2004 be considered "anytime, same disease" because the lung cancer now is the same type as previously?  OR would the 2004 chemo be considered "unrelated, > 6 months" because no chemo was given pre-op for the current increase in size of the R-sided mass?

Yes, as per the data definition - "indicate whether the prior chemotherapy treatment was received any time prior to this hospitalization to treat this occurance or any previous occurance of the same primary disease process that is being treated during this hospitalization."

NEW!

10/06

Message: A pt. had chemo/xrt for cancer of the tonsil. She developed an esophageal stricture and requires dilation. Would the xrt be considered "anytime - same disease" because it is the xrt that caused the stricture... even though the category is esophagus - benign.

The Category is Esophagus-benign.  The PreopChemoWhen field should be coded as an unrelated disease (to the appropriate timeframe - harvest code 2 or 3).

400

Preoperative Thoracic Radiation Therapy

Indicate if the patient has received preoperative radiation therapy to the chest for any reason prior to this operation.  May be included as a component of a chemotherapy radiation induction therapy.  This item should also be selected if the radiation oncologist gave the patient radiation therapy prior to sending the patient for any surgical evaluation, if the intent of the radiation oncologist was to "shrink the tumor" prior to surgical intervention. 

3/06

Does this sequence number only refer to RT to the chest? 

A patient has had gamma knife therapy for a metastatic renal cell carnioma who now has a new metastatic lesion in the hilum.

Yes, Pre-Op Thoracic Radiation Therapy only refers to RT to the chest related to the surgery

405

Preoperative Thoracic Radiation Therapy - When

Indicate whether the prior radiation therapy was:  Harvest:    Yes

                   1 = received any time prior to this hospitalization to treat this occurrence or

                          any previous occurrence of the same primary disease process that is

                          being treated during this hospitalization

                   2 = received within 6 months of this hospitalization to treat an unrelated disease

                   3 = received more than 6 months prior to this hospitalization to treat an unrelated

                        disease.

410

Prior Cardiothoracic Surgery

Indicate whether the patient has undergone any prior cardiac and/or general thoracic surgical procedure that required a general anesthetic and an incision into the chest or mediastinum.  A thoracotomy, median sternotomy, anterior mediastinotomy or thoracoscopy would be included here.  A cervical mediastinoscopy or tube thoracostomy would not be included.

420

When Prior CT Surgery was Performed

Indicate when the prior cardiac and/or general thoracic surgery was done.  If patient has history of more than one prior cardiac and/or general thoracic surgery, indicate the time frame for the most recent procedure.

430

Other comorbidity

Indicate whether the patient had one or more other co-morbidities not listed above.

3/06

What are some examples of "other cormorbidities not listed above?"

Pulmonary Embolism and Atrial Fibrillation prior to surgery

440

Tobacco use - None

Indicate if the patient has had No tobacco use.

450

Smokeless tobacco use

Indicate whether the patient has a history of using smokeless tobacco.

460

Cigarette use

Indicate whether the patient has a history of using cigarettes.

470

Pack-years of cigarette use

Indicate the number of pack-years by multiplying the average number of packs of cigarettes smoked per day by the number of years of smoking.  For example if the patient smoked 1 ppd for 10 years and 3 ppd for the next 10 years, the average ppd would be 2 ppd x 20 years = 40 pack-years of smoking.

480

Pipe or cigar use

Indicate whether the patient has a history of using pipe or cigars.

490

Other tobacco use

Indicate whether the patient has a history of any other tobacco or tobacco related product use.

500

When Patient Quit Smoking

Indicate how many days prior to the operation the patient quit smoking.  Choose “0-14 days pre-op” of the patient is a current smoker.

510

Cerebrovascular history

Indicate whether the patient has a history of Cerebro-Vascular Disease, documented by any one of the following: Unresponsive coma > 24 hrs; CVA (symptoms > 72 hrs after onset); RIND (recovery within 72 hrs); TIA (recovery within 24 hrs); Non-invasive carotid test with > 75% occlusion.; or Prior carotid surgery.  Does not include neurological disease processes such as metabolic and/or anoxic ischemic encephalopathy.

522

Diabetes

Indicate whether the patient has a history of diabetes, regardless of duration of disease or need for anti-diabetic agents.  Includes on admission or preoperative diagnosis.  Does not include gestational diabetes.

525

Diabetes control

Indicate the diabetic control method the patient presented with on admission.  Patients placed on a pre-operative diabetic pathway of insulin drip but at admission were controlled with “None”, diet or oral methods are not coded as insulin dependent.  Choices are :

                None = No treatment for diabetes

                Diet = Diet treatment only

                Oral = Oral agent treatment only

                Insulin = Insulin treatment (includes any combination with insulin)

530

Renal insufficiency history

Indicate whether the patient has:  Harvest:    Yes

                   1. a documented history of renal failure and/or

                   2. a history of creatinine > 2.0. 

Prior renal transplant patients are not included as pre-op renal failure unless since transplantation their creatinine has been or currently is > 2.0.

540

Clinical stage n/a

Indicate if clinical staging is not applicable.  Clinical stage is defined as stage of cancer based on non-operative techniques (history, physical exam, radiological tests).  For benign disease, or pulmonary metastases of any type, pathological staging is not applicable.

4/04

Lung and Esophageal cancer staging is the only staging applicable in the STS General Thoracic Database. 

4/04

Please define the difference between clinical staging and pathological staging.

Clinicopathological staging of cancer:  Staging is the clinical or pathological assessment of the extent of tumor spread.

Clinical staging is a preoperative assessment.  It is based on clinical, radiological and operative information.  Clinical Staging is used to determine treatment offered to patients.

Pathological staging is a postoperative assessment that is based on pathological testing results.  Provides useful prognostic information and allows decisions to be made regarding adjuvant therapy.

3/06

If patient has had a recurrence of a lung primary---document current stage of cancer, or stage when the primary was initially diagnosed?

If the patient goes to the OR for a recurrence of a lung primary, stage for the current procedure

NEW!

10/06

How would you clinically stage a patient who has a lung nodule which the surgeon isn't sure if it's a primary lung cancer or a met from another site?

Please document any preop lung or esophageal cancer clinical staging.  If clinical staging is not documented preoperatively, "No" should be documented.  Lung and esophageal cancer staging is the only staging applicable in the STS General Thoracic Database.  

NEW!

10/06

Short Field Name: Clinical Staging
  Message: I have a patient who has Stage 4 breast cancer with mets to bone and liver. The procedure performed was a VATS with talc pleurodesis. The pleural fluid did not contain any malignant cells. Should the staging question be answered in regards to any lung involvement? Which appears to be negative or unknown at this time, or should the staging be based on her breast cancer?

No, there is no clinical staging of breast cancer in this database (only lung and esophageal). 

550

Clinical stage T

Indicate the appropriate descriptor for tumor based on all the clinical staging characteristics of the tumor.  (See Appendix A for full description.)

560

Clinical stage N

Indicate the appropriate descriptor for nodes based on all the clinical staging characteristics of the lymph nodes.  (See Appendix A for full description.)

570

Clinical stage M

Indicate the appropriate descriptor for metastases based upon all the clinical staging characteristics of the metastases.  (See Appendix A for full description.)

580

Clinical stage Ma, b

Indicate for esophagus procedures only the clinical staging of Ma, b.  (See Appendix A for full description.)

590

Preop PFTs not done

Indicate whether Pulmonary Function Tests (PFT’s) were not done prior to this operation.  PFT’s done > 12 months prior to the primary surgical procedure should be coded as “No”.

595

FVC Test Not Done

Indicate whether a Forced Vital Capacity (FVC) test was done.

600

FVC actual

Indicate the actual FVC obtained for the patient.

4/04

Should we be recording pre-bronchodilator or post-bronchodilator values?

If both the pre-bronchodilator and post-bronchodilator values are recorded, collect the better of the two results.

610

FVC predicted

Indicate the % predicted FVC obtained for the patient.

4/04

Should we be recording pre-bronchodilator or post-bronchodilator values?

If both the pre-bronchodilator and post-bronchodilator values are recorded, collect the better of the two results.

615

FEV1 Test Not Done

Indicate whether a Forced Expiratory Volume at 1 second (FEV1) test was not done.

620

FEV1 actual

Indicate the actual FEV1 obtained for the patient.

4/04

Should we be recording pre-bronchodilator or post-bronchodilator values?

If both the pre-bronchodilator and post-bronchodilator values are recorded, collect the better of the two results.

630

FEV1 predicted

Indicate the % predicted actual FEV1 obtained for the patient.

4/04

Should we be recording pre-bronchodilator or post-bronchodilator values?

If both the pre-bronchodilator and post-bronchodilator values are recorded, collect the better of the two results.

635

DLCO Test Not Done

Indicate whether a lung diffusion measured with carbon monoxide (DLCO) test was not done.

650

DLCO predicted

Indicate the % predicted DLCO value obtained for the patient.