STS National Database May Facilitate 'Precision Medicine' in Readmission Study

STS News, Summer 2016 -- Data from the STS National Database are being utilized in a study to understand predictors of 30-day readmission and 30-day death after heart surgery in children and adults.

The study, which began in 2014 and is expected to conclude in 2018, is funded by a $3.2 million grant from the National Heart, Lung, and Blood Institute. Jeffrey P. Jacobs, MD, Chair of the STS Workforce on National Databases, is the site principal investigator (PI) for the Society. The project PI is STS Associate Member Jeremiah R. Brown, PhD, Associate Professor of Health Policy and Clinical Practice at The Dartmouth Institute and Geisel School of Medicine at Dartmouth.

More than 253,000 people undergo cardiac surgery each year, and approximately 20% of them are readmitted within 30 days for complications from surgery or comorbid conditions, Dr. Brown said. But little is known about the predictors of readmission.

The researchers are working to develop a novel, multi-systemic predictive model that combines perioperative biomarkers of cardiac injury (ST2, B-type natriuretic peptide, cardiac troponin T), renal injury (cystatin C), and non-specific inflammation (galectin-3, cytokines).

“Preliminary work by others in heart failure and by our investigators suggests that these novel biomarkers could help to identify patients at higher risk of readmission or mortality prior to discharge,” Dr. Brown said. 

The congenital arm of the research will utilize the STS Congenital Heart Surgery Database for data on 30-day readmission.

“This study is unique because it represents the first time that data about biomarkers are being linked to clinical data from the STS National Database,” said Dr. Jacobs, Chief of Cardiovascular Surgery at Johns Hopkins All Children’s Hospital and Professor of Surgery at Johns Hopkins University. “This may be the first example of a strategy that allows the clinical data in the STS National Database to facilitate precision medicine, where medical and surgical therapy is tailored to the unique genetic or biochemical profile of the individual patient. Indeed, this initiative represents an initial attempt to link clinical data from STS to data related to genomics, proteomics, lipidomics, and metabolomics, and therefore, this analysis explores an exciting new frontier with unlimited potential.”

"This may be the first example of a strategy that allows the clinical data in the STS National Database to facilitate precision medicine."

Jeffrey P. Jacobs, MD

Early results were presented at the STS 52nd Annual Meeting this past January and are expected to be published in The Annals of Thoracic Surgery. Additional results will be submitted as abstracts for the STS 53rd Annual Meeting in January 2017 and as papers to The Annals.

Ultimately, the researchers plan to create an online risk calculator that physicians can use to predict 30-day readmission or mortality in their cardiac surgery patients.

“If we can improve our ability to identify high-risk patients for readmission or mortality before they leave the hospital, we may succeed in reducing 30-day readmission rates and 30-day mortality while improving transitions from the hospital,” Dr. Brown said.

For more information about this study or the STS Research Center, contact Robert Habib, STS Research Center Director, at Robert Habib.