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

660

ASA class 1-5

Indicate the patient’s American Society of Anesthesiologists Risk Scale for this admissions surgical procedure.  This information can be found in the OR Anesthesia Record.

670

Time when patient entered Operating Room

Indicate to the nearest minute (using 24 hour clock) the time the patient enters the OR.

680

Time of skin opening

Indicate to the nearest minute (using 24 hour clock) the time the skin incision was made.

690

Time of skin closure

Indicate to the nearest minute (using 24 hour clock) the time the skin incision was closed.  If patient leaves the OR with an open incision, collect the time the dressings were applied to the incision.

700

Time when patient exits Operating Room

Indicate to the nearest minute (using 24 hour clock) the time the patient exits the OR.

710

Did operation go through midnight (24:00)

Indicate whether the operation continued through midnight from one day to the next.

720

Clinical Status of the Patient

Select the status that best describes the clinical status of the patient at the time of the primary surgical procedure.

                   1. Emergent: The surgical procedure must be performed within 24 hours of

                       presentation.

                   2. Urgent: 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.

                   3. Elective: The patient has been stable in the days or weeks prior to the operation. 

                       The procedure could be deferred without increased risk of compromise the

                                cardiac outcome.

725

Reoperation

Indicate whether this is a general thoracic re-operation: i.e., patient has a history of a general thoracic surgical procedure in the same cavity or organ any time prior to this operation.

3/06

Reop - a patient has had a prior thoracentesis, is the answer "yes."

The definition states, "Indicate whether this is a general thoracic re-operation: i.e., patient has a history of a general thoracic surgical procedure in the same cavity or organ any time prior to this operation.

For a thoracentesis to be coded as Reop=Yes, the thoracentesis would have had to have been done in the OR as an operation versus a very minor procedure in a hospital room or doctors office and the primary procedure needs to also be a pleural procedure.

NEW!

10/06

Short Field Name: Reoperation
  Message: A patient has primary lung cancer and had a previous mediastinoscopy.  He comes in now with primary lung cancer and has a right thoracotomy with mediastinal lymph node dissection and right upper lobectomy.  Is reoperation "yes" because he had a mediastinal procedure in the past and is now having the mediastinum re-entered for a lymph node dissection or "no" because the previous procedure was a mediastinoscopy and the current procedure is a thoracotomy?  Are you trying to get at whether or not the same cavity/organ has been surgically entered before or whether or not the approach into that cavity/organ is the same?

Reoperation is "No" because the previous procedure was a mediastinoscopy and the current procedure is a thoracotomy and lobectomy.  The primary purpose for each procedure was different.  The mediastinoscopy is not the same procedure as the thoracotomy and lobectomy.

730

Organ system

Indicate the organ system on which the surgical procedure is being performed.

740

Procedure

Indicate the general thoracic procedures being performed during this operating room visit.  Please note:  A separate General Thoracic Database Data Collection Form should be completed for each general thoracic operating room visit.

4/04

What are considered open pleural drainage procedures and what are considered closed pleural drainage procedures?

Open pleural drainage procedure would include video thoracoscopy or thoracotomy for drainage of effusion. 

Closed pleural drainage procedure would include placement of chest tube, tube thoracostomy, placement of pleur-x catheter, other drainage tube, or even thoracentesis.

4/04

Do we need to fill out an additional data collection form for a patient that returns to the OR for a tracheostomy or a esophageal dilation? I ask because these are post-op event choices. With this new version you say you want a collection form for every trip to the OR. Which is correct?

The General Thoracic Data Specifications do state that a new Data Collection Form (DCF) is needed for each visit to the OR, seq# 740, Procedure, definition:

Indicate the general thoracic procedure being performed during this operating room visit.  Please note:  A separate General Thoracic Database DCF should be completed for each general thoracic operating room visit.

With the examples that you have given, capture the postoperative tracheostomy or esophageal dilation in section "E" Post Op Events.  If the patient returns to the OR for these procedures, you also need to complete a DCF to capture the return visit to the OR.  If the patient does not return to the OR for these procedures, capture the procedures in section "E" and do not fill out an additional DCF.

8/04

Should we include Enterostomy as a procedure in the General Thoracic Database?  If yes, which procedure should we code?

Seq# 740, version 2.06:  An enterostomy is an operation in which the surgeon makes a passage into the patient's small intestine through the abdomen with an opening to allow for drainage or to insert a tube for feeding. The opening is called a stoma.  Enterostomies may be either temporary or permanent. They are classified according to the part of the intestine that is used to create the stoma. If the ileum, which is the lowest of the three sections of the small intestine, is used to make the stoma, the operation is called an ileostomy. If this is the procedure that your surgeon has done, collect under Esophagogastric, Other GI procedures.  If the jejunum, which is the middle section of the small intestine, is used, the operation is called a jejunostomy. If this is the procedure that your surgeon has done, collect under Esophagogastric, Jejunostomy.  

8/04

Do we collect data on Bronchoscopy procedures, in the General Thoracic Database?  What if it is the only procedure done in the OR? 

If the Bronchoscopy is done in the postoperative period due to a complication, code in the "Post Operative Events" section under "Atelectasis req bronch" or "Other pulmonary event." 

If the patient has a Bronchoscopy done as the primary surgical procedure and/or as the only procedure, this should be coded under seq# 740, Tracheobronchial:  Flexible Bronchoscopy or Rigid Bronchoscopy.

3/06

Thoracic physicians may perform operations to insert venous access devices (Port A Cath.)  Do we collect data on these procedures?  If so what type of procedure are they?

The GTDB FAQ v2.06 General Statement #2 states, "The General Thoracic Database:  1.) Disigned to capture all General Thoracic procedures performed in the OR (OR Endoscopy Suite, Out Patient Surgical Center) by a General Thoracic Surgeon (i.e., include those General Thoracic procedures that generate an operative note..."

Insertion of a Port A Cath would generate an operative note, so it would be included. It can be coded as Seq#740 Proc=Other Mediastinal/neck procedure or a custom field could be created to capture.

3/06

A patient has a left pleur-x catheter placed one day, the right placed two days later prior to his thoracic surgery.  Should a DCF be completed for each pleur-x cahteter placement?

If the pleur-x catheters were placed in the OR, generate a DCF for each placement and for the actual thoracic surgery.

3/06

Pneumonolysis is the separation of an adherent lung from the pleura.  Should this be documented as "other lung procedure" or "other pleural procedure."

Pneumonolysis should not be coded as a separate procedure. There is a primary procedure done in conjunction with Pneumonolysis.

3/06

If our organization is registered with the STS as an institution are we required to complete a separate case report form for each operating room visit regardless if an incision was made and/or it is the only procedure done during the operating room visit (i.e. bronchoscope procedures?)  Several pulmonary physicians or general surgeons may perform some of the thoracic procedures (less invasive procedures) listed in Section D during a patient’s hospitalization.  If we do complete separate DCF’s for all OR visits including bronchoscopes do we leave the questions regarding skin incision time and approach blank.  

Yes, leave those fields blank. As an STS participating Thoracic Surgery site, please capture data on cases done by Thoracic Surgeons only. If a patient has a bronchoscopy done by a pulmonologist, the case should not be included in the STS GTDB.

3/06

After reading the FAQ for return to OR (740) it was not clear to me. I had a patient that returned to the OR for removal of a hematoma, then he returned for a redo thorocotomy for air leak resulting in a pleurodesis.  These returns were captured as post op complications.  The hematoma was capture in the other category pulm event.  And the air leak was captured in post op complications air leak > 5 days. DO we capture all returns to the OR on separate tools even if they are related to complications? Thank you

Yes, all returns to the OR are collected on separate DCF's

3/06

A patient who underwent a myocardial revascularization went to back the OR for a mediastinal exploration which resulted in an evacuation of a hematoma. Is a  data collection form completed for this “exploratory” thoracic surgery. 

If you participate in the STS Adult Cardiac National Database, the re-exploration would be coded as Seq# 2710 Complics=Yes; Seq#2760 COpReNon=Yes. If you participate in the STS General Thoracic Database, code Seq# 740 Proc=Other Mediastinal/neck procedure. If you participate in both the Adult Cardiac and GTDB, code as above. The patient would be entered in both databases.

3/06

A patient’s has a flexible thoracoscopy and placement of a CT to drain recurrent empyema.  Is the placement of the CT considered a open or closed pleural drainage procedure 

If the flexible bronchoscopy and CT placement was done in the OR, the procedure would be coded as "Open"

3/06

A patient has had an Infuse-A Port placed during her thoracic procedure.   If collecting this information under what category (procedure) should it be included. 

This is procedure would be coded as either Other Mediastinal/neck procedure or in a user-created custom field

3/06

Typically a chest tube is inserted during an open thoracic procedure.  Do you capture this placement of the chest tube as a closed pleural drainage procedure?  Or is this only to be “checked” if the chest tube placement is specifically for a pleural effusion?  

Code Seq# 740 as Pleural drainage procedure-closed or opened if the chest tube is inserted for a pleural effusion. The chest tube is inserted after an open thoracic procedure to regulate the change in pressure in the pleural space and is considered part of the procedure.

3/06

Surgery was done on a patient.  The surgeon performed a thorocotomy for a paraspinal mass.  It is not clear as to which category to capture this surgery.  The path report was negative stating consistent with bronchogenic

There is no field for a paraspinal mass. It could be coded as Other Mediastinal (if approach was through the mediastinum) or Other Tracheobronchial. The key is to be consistent in coding all paraspinal mass surgeries at your site.

NEW!

10/06

Is there a way to capture an Internal Mammary artery pedicle flap as an anastomotic reinforcement to the bronchial stump after a sleeve lobectomy OR is this an other procedure?

other air leak control measures

NEW!

10/06

Proc
  Message: Do we include Aortic Aneurysm repair in this data base (Repair/Reconstruction thoracic aorta)? 

Yes, if the repair was conducted by a cardiothoracic surgeon.  Please indicate whether the repair was Repair/Reconstruction thoracic aorta or Repair/Reconstruction abd aorta.

NEW!

10/06

Biopsy
  Message: If the patient has a wedge done for a small nodule removal is this a wedge resection or should this be coded as a lung biopsy?

Code as Wedge Resection.  Whether diagnostic or interventional, it is still a wedge resection of the lung.

NEW!

10/06

Short Field Name: Air Leak
  Message: When the surgeon covers the bronchial stump with tissue is this to be captured as an air leak control?

Yes, code as "Other Air Leak Control Measures".  Note:  Air leak measures are defined on the Clinical Support website document "General Thoracic Surgery Database Procedures Defined".

NEW!

10/06

Short Field Name: cardiac/pericardium/great vess
  Message: For patients that are having an Isoalted procedure for pericardial window, repair cardiac laceration or any other procedure in this field.  Is it better to capture these procedures in the GTS database or should I capture them in the Adult Cardiac Surgery database as an other, knowing that all the data elements may not be completed?

The GTS database should be used to capture all general thoracic procedures performed in the OR (OR, Endoscopy Suite, Out Patient Surgical Center) by a participating General Thoracic surgeon.

NEW!

10/06

Short Field Name: Check all procedures
  Message: When the thoracic physician assist ENT or Neuro and does an access thoracotomy should this assist procedure be captured?  If so how should it be captured?

No.  The current database does not hae a field to capture the assist at this time.  Further database upgrades will consider this option.

750

Primary

Indicate whether this is the primary surgical procedure.

3/06

The following procedures were done during the same surgical procedure:  flexible broncoscopy, multiple wedge resection, lobectomy and a mediastinal LN biopsy. What criteria should be used for selecting the “primary” procedure? 

The primary procedure in the scenario presented is the lobectomy. The flexible bronch was most probably diagnostic, the wedge resections and lymph nodes were for biopsy to determine if the entire lobe would need to be removed.
Criteria for selecting primary procedure is to select the most "invasive" or the procedure that removes the most tissue.

NEW!

10/06

Primary
  Message: If the patient has a Mediastinoscopy and Lymph Node Biopsy - or any type of tissue biopsy from the mediastinum, which is the "Primary" - the Med or the biopsy procedure?  The Med itself seems the "most invasive" but the biopsy "removes the most tissue".

In this example, the primary procedure is the Mediastinoscopy.  If a Mediastinal Lymph Node Biopsy was the only procedure conducted, it would be the primary.

NEW!

10/06