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

751

Approach - Thoracoscopy

Indicate whether a Thoracoscopy approach was used for the primary surgical procedure.

3/06

Regarding the primary procedure it is requested to select the approach.  Since you can only select one primary procedure are you requesting the approach only for that procedure?  Clarification is needed since in parenthesis is (select all that apply.)  

It is possible to have multiple attempted approaches to the one procedure that was coded as the primary procedure. For example, if the primary procedure was a Wedge Resection-Singe that was started with a Thoracoscopic (Seq# 751) approach that ended up having to be converted to Thoracotomy (752), both 751 and 752 would be selected.

NEW!

10/06

Our surgeon is using the DAVINCI robot for thoracoscopy approach. We are capturing the use of this robotics by the surgical approach used. Is this correct or should it be captured as other?

Correct.  If you need to distinguish DAVINCI from regular thoracoscopy, you can add a custom field.

752

Approach - Thoracotomy

Indicate whether a Thoracotomy approach was used for the primary surgical procedure.

753

Approach - Thoracoabdominal

Indicate whether a Thoracoabdominal approach was used for the primary surgical procedure.

754

Approach - Median Sternotomy

Indicate whether a Median Sternotomy approach was used for the primary surgical procedure.

755

Approach - Partial Sternotomy

Indicate whether a Partial Sternotomy approach was used for the primary surgical procedure.

756

Approach - Transverse Sternotomy

Indicate whether a Transverse Sternotomy approach was used for the primary surgical procedure.

757

Approach - Laparotomy

Indicate whether a Laparotomy approach was used for the primary surgical procedure.

758

Approach - Laparoscopy

Indicate whether a Laparoscopy approach was used for the primary surgical procedure.

759

Approach - Cervical

Indicate whether a Cervical approach was used for the primary surgical procedure.

760

Approach - Subxyphoid

Indicate whether a Subxyphoid approach was used for the primary surgical procedure.

761

Approach - Other Approach

Indicate whether any other approach was used for the primary surgical procedure.

NEW!

10/06

Is a Chamberlain Procedure considered the same as the Anterior Mediastinoscopy? What would be the approach?

Yes.  It should be coded as "ApprOther".

765

Laterality

Indicate the laterality of the primary surgical procedure.

NEW!

10/06

Short Field Name: Laterality
  Message: "Laterality" gives a choice of left, right, or both.  I think of "both" as entering both the left and right sides, as is sometimes the case in some procedures.  How do you want us to code in the case of midline procedures, for example esophagoscopy?  Putting "both" is not really correct.  I've tried leaving the field blank, and can't get the procedure to validate.  Will STS accept a blank in this field for a midline procedure?  Please advise.

For your example and given the options in the current database the Laterality should be left blank/null.  Leaving this field blank will not result in this record being excluded from analysis.  It will be reported as missing data though in your site's data quality report.  Additional laterality options will be considered in future database revisions.

8/04

GENERAL STATEMENT

Section “E”, Post Operative Events

The postoperative period, in which postoperative events can be captured, is defined as one of the following:

     1.  Immediately postoperatively until discharge from the acute care facility, if discharged > 30 days after procedure.

     2.  Immediately postoperatively, up to 30 days, if discharged from the acute care facility prior to 30 days. 

770

No postop events occurred

Indicate whether the patient did not experience any postoperative events.

775

Postop Events Occurred

Indicate whether the patient experienced any postoperative events.

3/06

How should we collect intra-operative complications?  

There is currently no intraoperative complication fields in the GTDB. If there is a desire to track intraoperative complications, these will have to be collected as custom fields.

3/06

Just because a person is taken back to the OR doesn't necessarily mean it is due for a complication.  At our institution, post sleeve or tracheal resection anastomosis check, etc are standard of care.  In these instances, would this be considered a complication? 

No. If this is the standard practice, it would not be coded as a postoperative event. However, if a patient did go back for a planned procedure, a new data collection form would need to be initiated for the 2nd procedure.

NEW!

10/06

When tracking post op events, do we collect complications on procedures we do for/with other services - IE exposures & closures, tracheostomy, etc?  What about traumas? 
Examples:
Cardiac surgery pt needs trach for resp failure.  Any subsequent complications after trach is a thoracic complication?
Pt who has resp failure from prior existing condition with/without other surgeries.  Any subsequent complications after trach is a thoracic complication?
We perform exposure or other assistance with another service.  Any subsequent complication after other service surgery is a thoracic complication?

All postoperative events should be documented.

NEW!

10/06

Message: In your new FAQ's, the beginning of section E describes the time period over which post-op events can be captured (through DC if DC is >30d's from the procedure and for up to 30 d's from procedure if the pt is discharged before 30 d's).  My question is what events to capture.  Your new 2.07 FAQ's under general statement #2 say the post op events section is designed to only capture those postop events that result from the General Thoracic procedure for which the DCF was generated in the first place.  Please consider the following scenario:  a 64 yo woman has a large mediastinal mass plus separate lung masses. She is bronchoscoped by our thoracic surgeon in the OR. Biopsies can be done of the mediastinal mass because it has invaded the trachea.  She has small cell lung CA.  No post op problems relate to the bronchoscopy.  Due to her disease and chemo/radiation, however, she develops SIADH; nausea, vomiting and pain requiring gastroscopy (done by GI), a UTI, needs blood transfusion, and ileus.  Do these all get coded as events even though they don't relate to the bronch?  Also, 10 d's after the bronch she had a port-a-cath but in by another surgeon (not someone we code in this database).  Does the timing of this second procedure have any significance in terms of the post-op events for our earlier procedure?  Please clarify. Thank you.

For your scenario:  1.  No, these GI, UTI and other events following an uneventful bronchoscopy would not be coded.                                                                         2.  Only participating cardiothoracic surgeons should have procedures coded in the database.

790

Air leak with a duration of more than five days postop

Indicate whether the patient experienced an air leak for more than five days post-operative.

850

Atelectasis requiring bronchoscopy

Indicate whether the patient experienced atelectasis requiring a bronchoscopy in the post-operative period.

860

Patient experienced pneumonia postoperatively

Indicate if the patient experienced pneumonia in the post-operative period.  Pneumonia is defined as meeting three of five characteristics: fever, leukocytosis, CXR with infiltrate, positive culture from sputum, or treatment with antibiotics.

3/06

If a patient has an infection other than pneumonia, they will usually have fever, treatment w/ antibiotics and leucocytosis.  Those are three of the five criteria for pneumonia even though it may not be a true pneumonia.  Clinical judgement is therefore warranted.  Can something to that affect be added to the specifications?

The definition states, "…Pneumonia is defined as meeting 3 of the 5 criteria: fever, leukocytosis, CXR with infiltrates, positive culture from sputum, or treatment with antibiotic." Patients with Pneumonia are will usually have some progress notes stating "rule out pneumonia" or "diminished lung sounds". Will consider changing definition for the next upgrade.

870

Patient has evidence of Adult Respiratory Distress Syndrome

Indicate whether the patient has evidence of ARDS (Adult respiratory distress syndrome).  According to the American-European consensus conference, a diagnosis of ARDS is assigned if all of the following criteria are present:

                   1. Acute onset

                   2. Arterial hypoxemia with PaO2/FIO2 lower than 200 (regardless of PEEP level)

                   3. Bilateral infiltrates seen on chest radiograph

                   4. Pulmonary artery occlusive pressure lower than 18 mm Hg or no clinical evidence

                             of left atrial hypertension

                   5. Compatible risk factors

880

Bronchopleural fistula

Indicate if the patient experienced a documented bronchopleural fistula in the post-operative period.  Bronchopleural fistula is defined as a major bronchial air leak requiring intervention such as a chest tube, operation, or other procedure.

890

Pulmonary embolus

Indicate whether the patient experienced a Pulmonary Embolus in the post-operative period as experienced by a V/Q scan, angiogram or spiral  CT.

900

Initial vent support >48 hours

Indicate if the patient initially was ventilated greater than 48 hours in the post-operative period.  If the patient is extubated prior to 48 hours, this item would not be selected.  If the patient is reintubated, please select the postoperative event "reintubation" and do not select this element even if the reintubation ventilator support is > 48 hours.  Ventilator support ends with the removal of the endotracheal tube or if the patient has a tracheostomy tube, until no longer ventilator dependent.

910

Reintubate

Indicate whether the patient was re-intubated during the initial hospital stay after the initial extubation.  This may include patients who have been extubated in the OR and require intubation in the postoperative period.

NEW!

10/06

If a patient is reintubated for a planned bronch post-op - does this count as a reintubation complication??

No.  Procedure was planned.

920

Tracheostomy

Indicate whether the patient required a tracheostomy in the post-operative period.

4/04

Tracheostomy done intraoperatively, during the initial operation, should not be captured in this field.

930

Other pulmonary event

Indicate whether another pulmonary event occurred in the post-operative period.

3/06

An operative report was generated for an insertion of a pleurex catheter (for a recurrent pleural effusion.)  In the post operative period the patient was intubated due to increasing oxygen requirements and was intubated for >48hrs.  Since the patient was not intubated for the “operative” procedure reintubation (910) and initial vent support >48 hrs (900) is not applicable?  Should this be coded as other pulmonary event (930)? 

Yes, code as Other pulmonary event because the patient was not vented for the procedure.

3/06

Sequence #: 930, 980, 1040, 1070, 1150, 1200, 1210
The above sequence #'s are the "other" postoperative complications.  Can you give examples of what "other" events in each section will include?  IE reperfusion injury for other pulmonary, etc.

There is no easy answer to what to include in the "Other" postoperative complications. A good rule of thumb is to include but not limit to any postoperative event or complication that extends the length of stay or outcome of the patient.

The "Other" categories are not used in any analysis because it is too vague, so it really can be used to collect anything you want to collect that is not specifically included in the other complication fields.

940

Atrial arrhythmia requiring treatment

Indicate whether the patient, in the post-operative period, experienced atrial fibrillation and/or atrial flutter that has been clinically documented or treated with any of the following treatment modalities:

                   1. ablation therapy

                   2. permanent pacemaker

                   3. pharmacologic treatment

                   4. electrocardioversion

12/04

The intent of this field is to capture new onset atrial arrhythmias that occur in the postoperative period that have either been clinically documented or treated.  If a patient has a history of atrial arrhythmias preoperatively and the patient experiences atrial arrhythmias postoperatively, do not capture the reoccurrence of the atrial arrhythmias because the atrial arrhythmia is not new in onset. 

3/06

I know the criteria states new arrhythmia.  But, what if a patient has a pre-op arrhythmia and post-operative has arrhythmias which prolong their hospital stay and/or becomes uncontrolable, should we capture this as a complication?  

Yes. If the original treatment for the atrial arrhythmia does not control the arrhythmia, code Seq# 940 AtrialArryth = Yes

950

Ventricular arrhythmia requiring treatment

Indicate whether the patient, in the post-operative period, experienced sustained ventricular tachycardia and/or ventricular fibrillation that has been clinically documented or treated with any of the following treatment modalities:

                   1. ablation therapy

                   2. AICD

                   3. permanent pacemaker

                   4. pharmacologic treatment

                   5. electrocardioversion

960

Myocardial infarct

Indicate if the patient experienced a MI postoperatively as evidenced by:  Harvest:    Yes

                1. transmural infarction: Defined by the appearance of a new Q wave in two or more

                    contiguous leads on ECG, or

                2. subendocardial infarction: (nonQwave)  Infarction, which is considered present in a

                    patient having clinical, angiographic, electrocardiographic, and/or

                3. laboratory isoenzyme evidence of myocardial necrosis with an ECG showing no

                          new Q waves

970

DVT requiring treatment

Indicate whether the patient has experienced a deep venous thrombosis confirmed by doppler study, contrast study, or other study in the post-operative period.

980

Other cardiovascular event

Indicate whether any other CV event occurred including distal arterial embolism in the post-operative period.

990

Gastric outlet obstruction

Indicate whether the patient experienced a gastric outlet obstruction requiring intervention, e.g., IV for dehydration, endoscopy and dilation, reoperation, etc., in the post-operative period.

1000

Patient experienced an ileus postoperatively

Indicate whether the patient experienced an ileus lasting greater than three days as defined by limited GI motility requiring treatment e.g. nasogastric tube insertion for decompression, etc., in the post-operative period.

1010

Anastomosis requiring medical treatment only

Indicate whether the patient in the post-operative period experienced an esophageal anastomosis leak or abnormality that required medical management only, i.e., NPO, antibiotics, etc.  If a leak or an abnormality occurs on Barium Swallow only and does not require surgical intervention /drainage, i.e., treated with NPO and delay in oral intake, then code this element as “yes”.

1020

Anastomosis requiring surgical treatment

Indicate whether the patient in the post-operative period experienced an esophageal anastomosis leak or abnormality that required medical management only, i.e., NPO, antibiotics, etc.  If a leak or an abnormality occurs on Barium Swallow only and does not require surgical intervention /drainage, i.e., treated with NPO and delay in oral intake, then code this element as “yes”.  Indicate whether the patient in the post-operative period experienced an esophageal anastomosis leak that required surgical intervention or manipulation, i.e., reoperation (in the operating room or requiring general anesthesia, repeat thoracotomy for drainage and control of the leak) for the esophageal anastomotic leak.  Opening the neck incision for drainage at the bedside would be included here.

3/06

Is re-operation for conduit necrosis, etc. also included in "anastomosis requiring surgial treatment" section or is this for leaks only?

Yes, code Seq# 1020 AnastoSurg=Yes and initiate a new data collection form (DCF) for the procedure.

1030

Dilation of the esophagus prior to discharge

Indicate whether the patient required dilation of the esophagus within the post-operative period.

1040

Any other GI event occurred

Indicate if the patient experienced any other GI events in the post-operative period.

1050

Bleeding requiring reoperation

Indicate whether an operative reintervention was required for bleeding.

1066

Blood transfusion - Intraop

Indicate whether the patient received a blood transfusion intraoperatively.  Intraop is defined as any blood started inside of the OR.

1067

Blood transfusion - Postop

Indicate whether the patient received a blood transfusion postoperatively.   Postop is defined as any blood started after the initial surgery, including blood transfused after the initial surgery and any blood transfused during a reoperative surgery.

1070

Other hematology or bleeding event requiring treatment

Indicate if any other hematology/bleeding event requiring treatment occurred in the post-operative period such as Heparin Induced Thrombocytopenia.

1080

Urinary tract infection

Indicate if the patient experienced a urinary tract infection (with Positive Urine Cultures postoperatively) requiring treatment.

1090

Patient experienced empyema requiring treatment

Indicate whether the patient experienced an empyema requiring treatment in the post-operative period, i.e., chest tube drainage by interventional radiology, etc.

1100

Wound infection

Indicate whether the patient experienced a wound infection in the post-operative period as evidenced by meeting two of the following criteria:

                   1. Wound opened with excision of tissue (I&D)

                   2. Positive culture

                   3. Treatment with antibiotics

1110

Patient experienced sepsis (septicemia)

Indicate whether the patient experienced septicemia requiring positive blood cultures in the post-operative period.

1130

New central neurological event

Indicate whether the patient experienced any of the following neurological events in the post-operative period that was not present pre-operatively:

                   1. A central neurologic deficit persisting postoperatively for > 72 hours.

                   2. A postoperatively transient neurologic deficit (TIA recovery within 24 hours;

                       RIND recovery within 72 hours).

                   3. New postoperative coma that persists for at least 24 hours secondary to

                       anoxic/ischemic and/or metabolic encephalopathy, thromboembolic event or

                      cerebral bleed.

1140

Recurrent laryngeal nerve paresis

Indicate whether the patient experienced in the postoperative period a recurrent laryngeal nerve paresis or paralysis that was not identified during the pre-operative evaluation.

1150

Other neurological event

Indicate whether the patient experienced any other neurologic event in the post-operative period.

1160

New renal failure

Indicate whether the patient experienced renal failure in the post-operative period as documented by acute or worsening renal failure resulting in one or more of the following:

1.        increase of serum creatinine to > 2.0 and 2x most recent preoperative creatinine

2.       a new requirement for dialysis postoperatively

NEW!

10/06

Short Field Name: New renal failure
  Message: A patient has a history of acute renal failure with creatinine's >3.0 in Aug 05.  He comes in for a left ventricular lead placement in June 06.  Creatinine on admission is 1.0.  Post op his creatinine goes as high as 3.1 before coming down.  Do I code renal failure as a complication or not given he has a past history of creatinine >3 but also had a normal creatinine on admission?

Yes, it should be coded as "New Renal Failure"; as per the definition there has been an increase of serum creatinine to > 2.0 and 2x most recent preoperative creatinine level.

1170

Chylothorax requiring drainage/medical treatment only

Indicate whether the patient experienced a chylothorax in the post-operative period that required drainage and medical intervention, i.e., NPO, TPN, etc., only.  Chylothorax requiring surgical intervention, i.e., thoracotomy, laparotomy, thoracoscopy, etc., should not be captured here.

1180

Chylothorax requiring surgical intervention

Indicate whether the patient experienced a chylothorax in the post-operative period  requiring surgical intervention, i.e., thoracotomy, laparotomy, thoracoscopy, etc.

1190

Delirium tremens

Indicate whether the patient experienced delirium tremens in the post-operative period marked by illusions, confusion, cerebral excitement, and having a comparatively short course.

3/06

Can you further define delirium tremens?  Is this only ETOH withdrawls or can encephalopathy, ICU psychosis, etc. be included?

No. Please include all of the symptoms mentioned for Seq# 1190 Delerium.

NEW!

10/06

Delirium Tremens
  Message: Delirium tremens refers to symptoms induced by excessive and prolonged use of alcohol which is not mentioned as a part of its definition here.  In the clarification written in 3/06, it appears that we are being told that any type of delirium should be included here.  If that is the case, the the field name should be changed to DELIRIUM rather than delirium tremens, a symptom of alcohol withdrawal.  Please clarify for everyone.

The clarification written on 3/06 remains correct.  In subsequent database revisions, the field name and data definitions may be revised, however in the meantime the field should be marked "Yes" if the patient experienced the symptoms listed.

1200

Other events requiring medical treatment

Indicate whether the patient experienced any other medical events in the post-operative period requiring medical treatment, including endoscopy.

3/06

If a patient has pneumothrax in which a chest tube was placed, should "other pulmonary event" be checked or "other events req medical Rx (incl. enodscopy)

Code Seq# 1200 OtherMed=Yes

1210

Other events requiring OR with general anesthesia

Indicate whether the patient experienced any other surgical events in the post-operative period requiring a procedure with general anesthesia.