In the 1970s and 1980s, it became evident that patients with coronary artery blockages could greatly benefit from coronary artery bypass grafting (CABG) surgery. This operation was an effective way to improve both quality of life and long-term survival. As CABG was performed with increasing frequency, it also became apparent that results varied among providers. Furthermore, differences in mortality rates often resulted not from the quality of care delivered but rather from differences in the underlying severity of patients. Older, sicker patients faced higher risks than younger patients with relatively fewer medical problems. Surgeons needed a way to measure their results, using accurate data, against an accepted standard that accounted for the risk of their patients. At that time such a benchmark simply did not exist.
Without national data, there was no way to assess accurately the results of CABG surgery. Recognizing this, The Society of Thoracic Surgeons designed a national database of heart surgery operations and, in 1989, began collecting data in what is now called the STS National Database (Database). The chief value of the Database has been the collection and analyses of data from across the country, which in turn has provided meaningful reports that local practices can use to compare their performance with similar groups and national benchmarks.
Initially, the Database, now known as the STS Adult Cardiac Surgery Database, collected data only on CABG and other adult cardiac surgery operations, such as aortic valve replacement (AVR). In subsequent years, however, STS began to collect information on pediatric and congenital heart surgery procedures, which ultimately helped create the STS Congenital Heart Surgery Database, and on non-cardiac chest surgery procedures, now comprising the STS General Thoracic Surgery Database.
Today, the STS National Database has three components:
1. The STS Adult Cardiac Surgery Database
2. The STS General Thoracic Surgery Database
3. The STS Congenital Heart Surgery Database
Participation in the Database has always been voluntary, and cardiothoracic surgeons increasingly have recognized a professional obligation to collect data and analyze outcomes as a means to quality improvement – a commitment that requires considerable time and expense for data collection. Enrollment in the Database has grown steadily, and today there are 1,071 cardiac surgery practices participating in the Database, representing more than 90 percent of all adult cardiac surgery centers across the country.