What is an STS Database Participant?

An STS Database Participant is an individual cardiothoracic surgeon or group of cardiothoracic surgeons that participate in The STS National Database.

What is a Coronary Artery Blockage?

It is a narrowing of the arteries around the heart such that oxygen-rich blood cannot reach the heart muscle.

What is Coronary Artery Bypass Graft (CABG) Surgery?

CABG is a surgical procedure that creates new routes around narrowed and blocked arteries. It allows a sufficient amount of blood to flow in order to deliver oxygen and nutrients to the heart muscle.

What is Aortic Valve Replacement (AVR) Surgery?

Aortic valve replacement (AVR) is a surgical procedure performed by cardiothoracic surgeons for treatment of narrowing (stenosis) or leakage (regurgitation) of the aortic valve.

What is Risk Adjustment?

It is a way to measure surgical results that takes into consideration how sick the patients were before treatment.

What is the Mortality Rate?

The mortality rate is the number of patients who died out of all the patients who had heart surgery.

What is the Complication Rate?

The complication rate is the number of patients, out of all the patients who had surgery, who left the hospital without any of the five most serious complications of cardiac surgery: reoperation, stroke, kidney failure, infection of the chest wound, or prolonged need to be supported by a breathing machine, or ventilator.

What is the Morbidity Rate?

This is another way of saying Complication Rate. 

What is the peri-operative period?

“Peri-operative” refers to all three stages of surgery: preoperative (before surgery), intra-operative (during surgery), and post-operative (after surgery).

What is a quality performance measure?

Quality performance measures are standardized measurement criteria that can be used to monitor, evaluate, and improve the quality of patient care.

CABG Overall Composite Star Ratings

STS uses 11 quality performance measures grouped appropriately to assess quality of care in cardiac surgery:

1.  Risk-adjusted mortality rate (defined above)

2.  Risk-adjusted morbidity rate (defined above)

3.  Use of a section of an artery from the chest wall in the bypass surgery.  This artery has been shown to function much longer than other grafts that can become blocked over time.

4.  Prescribing appropriate perioperative medications.

Each participant is scored in all of the four categories.  The scores are combined and the result is the overall composite score.  In addition to a composite score, each participant also is given a star rating of one to three stars.  Those participants who perform below average receive a star rating of one, average scoring participants receive a two star rating, and participants scoring above average receive a three star rating.

AVR Overall Composite Star Ratings

Surgical performance is measured based on a combination of the NQF-endorsed isolated AVR mortality measure and the same morbidity outcomes that make up the NQF-endorsed CABG morbidity measures. Please note that there are currently no NQF-endorsed AVR morbidity measures. STS uses six quality measures grouped appropriately to assess quality of care:

1. Risk-adjusted mortality rate (defined above)

2. Risk-adjusted morbidity rate (defined above)

Participants receive a score for each of the two domains, plus an overall composite score, which is calculated by “rolling up” the domain scores into a single number. In addition to receiving a numeric score, participants are assigned to a rating category designated by one to three stars.

Overall CABG Composite Score

The STS CABG composite score is calculated using a combination of 11 measures of quality divided into four broad categories or domains.

Absence of Operative Mortality

The first domain adjusts the results for each surgeon and hospital by accounting for the severity of their patients’ illnesses, a process commonly known as risk adjustment. To level the playing field, statistical techniques have been developed to account for the condition of patients before surgery.

Absence of Major Morbidity

A second domain is the risk-adjusted major morbidity rate, the percentage of patients who leave the hospital with none of the five most serious complications (often referred to as morbidities) —reoperation, stroke, kidney failure, infection of the chest wound, or prolonged need to be supported by a breathing machine (ventilator).

Use of Internal Mammary Artery

The third domain measures the percentage of CABG procedures that include the use of at least one of the arteries from the underside of the chest wall—the internal mammary (or internal thoracic) artery— for bypass grafting. This artery has been shown to function much longer than vein grafts, which can become blocked over time.

Receipt of Required Perioperative Medications

The fourth domain in the CABG composite score measures how often all of the four medications believed to improve a patient’s immediate and long-term outcomes were prescribed. Those drugs include beta-blocking drugs prescribed pre-operatively, as well as aspirin (or similar drugs to prevent graft clotting), and additional beta-blockers and cholesterol-lowering medicines prescribed post-operatively.

What is the National Quality Forum (NQF)?

The National Quality Forum (NQF) is a nonprofit organization whose function is, among other things, to approve and endorse quality performance measures. 

Adult Cardiac Surgery Operations

These are surgeries of the heart performed on patients aged 18 years and above, including CABG and heart valve surgeries.