What is the STS National Database?
The STS National Database was established in 1989 as an initiative for quality improvement and patient safety among cardiothoracic surgeons. The Database has since grown exponentially, both in terms of participation and stature, and has become the gold standard for clinical registries.
The STS National Database has four components, each focusing on a different area of cardiothoracic surgery—Adult Cardiac Surgery, Congenital Heart Surgery, General Thoracic Surgery, and mechanical circulatory support (Intermacs). By participating in the STS Adult Cardiac Surgery Database, General Thoracic Surgery Database, Congenital Heart Surgery Database, and/or the Intermacs Database, cardiothoracic surgeons demonstrate their commitment to improving the quality of care that their patients receive.
Participation in the STS National Database is global, currently spanning 11 countries on five continents.
What is an STS National Database Participant?
An STS National Database “Participant” is a cardiothoracic surgeon or group of cardiothoracic surgeons who agree to submit case records for analysis and comparison with benchmarking data for quality improvement initiatives. At the option of the surgeon or surgical group, the Participant can include a hospital and/or associated anesthesiologists (ACSD and CHSD).
What is the Adult Cardiac Surgery Database (ACSD)?
The STS Adult Cardiac Surgery Database (ACSD)—a component of the STS National Database—is the world’s premier clinical outcomes registry for adult cardiac surgery. Launched in 1989, the Database contains approximately 6.9 million cardiac surgery procedure records and currently has more than 3,800 participating physicians, including surgeons and anesthesiologists, representing more than 90% of all adult cardiac surgery hospitals across the United States and Canada.
ACSD participants can now publicly report their outcomes for isolated aortic valve replacement (AVR), isolated coronary bypass grafting (CABG) surgery, and/or AVR and CABG combined through STS Public Reporting Online. Mitral valve replacement/repair (MVRR) and MVRR+CABG public reporting also are now available.
What is the Congenital Heart Surgery Database (CHSD)?
The STS Congenital Heart Surgery Database (CHSD)—a component of the STS National Database—is one of the largest clinical registries in the world for congenital cardiac procedures. The CHSD contains approximately 515,000 congenital heart surgery procedure records and currently has 1,061 participating physicians, including surgeons and anesthesiologists, representing more than 95% of all congenital heart surgery hospitals in the United States and Canada.
CHSD participants can now publicly report their outcomes through STS Public Reporting Online.
What is the General Thoracic Surgery Database (GTSD)?
The STS General Thoracic Surgery Database (GTSD)—a component of the STS National Database—is the largest and most robust clinical thoracic surgical database in the United States and Canada. The GTSD contains more than 616,000 general thoracic surgery procedure records and currently has approximately 1,000 participating physicians.
STS Public Reporting Online for esophagectomy and lobectomy is now available.
What is the Intermacs Database?
The STS Intermacs Database became part of the STS National Database on January 1, 2018. It represents the next generation of Intermacs, a joint effort among the National Heart, Lung, and Blood Institute, the Food and Drug Administration, the Centers for Medicare & Medicaid Services, and others that was established in 2005 at the University of Alabama at Birmingham. Intermacs is a North American registry for the clinical outcomes of patients who receive an FDA-approved mechanical circulatory support device to treat advanced heart failure.
The addition of the Intermacs registry represents a new chapter in the history of the STS National Database in light of the registry’s collection of longitudinal data. The STS Intermacs Database includes longitudinal data for the life of a patient with an MCS device.
What is STS Public Reporting Online?
STS believes that the public has a right to know the quality of surgical outcomes and considers public reporting an ethical responsibility of the specialty. STS Public Reporting Online enables STS Adult Cardiac Surgery Database (ACSD), Congenital Heart Surgery Database (CHSD), and General Thoracic Surgery Database (GTSD) participants to report, on a voluntary basis, their surgery scores and star ratings. For participants enrolled in public reporting, overall composite star ratings and component ratings are listed on the STS website. As public reporting is completely voluntary, a participant may withdraw enrollment from the program at any time.
ACSD Public Reporting
ACSD participants can elect to publicly report outcomes for isolated aortic valve replacement (AVR), isolated coronary artery bypass grafting (CABG), and/or AVR and CABG combined. ACSD public reporting became available in late 2010. Mitral valve replacement/repair (MVRR) and MVRR+CABG reporting also are now available. Approximately 78% of ACSD participants are currently enrolled in public reporting.
STS publicly reports ACSD participant results at both the hospital and surgical group levels. Data for hospital-level public reporting are analyzed using the 10-digit hospital National Provider Identifier number. Data for surgical group-level public reporting are analyzed using the 5-digit participant identification number. Published data are identical to composite measure results provided to participants in their harvest report.
CHSD Public Reporting
STS Congenital Heart Surgery public reporting includes the designation of star ratings, which are based on the STS CHSD mortality risk model. Learn more detailed information regarding the CHSD mortality risk model and star ratings.
The STS CHSD public reporting initiative continues to grow, increasing from 23% of enrolled participants for the January 2015 data release to 89.7% in the current data release. Public reporting became available in early 2015 for CHSD participants.
STS publicly reports CHSD participant results at the hospital level. Final reports provide participants with results at the participant or group level, but these data are not published on the website.
GTSD Public Reporting
The General Thoracic Surgery Database (GTSD) public reporting includes a national report of outcomes from lobectomy (a lung cancer procedure that removes a portion of the lung), and as of summer 2019, esophagectomy.
For the first stage of GTSD public reporting, a list of all active participating institutions in the GTSD as of October 31, 2016, became available on the STS website; individual surgeons at each institution also were named.
In July 2017, participant-level outcomes for lobectomy were first publicly reported with comparisons to overall STS and national outcomes. Discharge mortality, median postoperative length of stay, and a two-domain lobectomy composite measure (including risk-adjusted mortality and major complications) were reported for consenting programs. Approximately 43% of GTSD participants are currently enrolled in public reporting.
What is the rationale of public reporting?
- Surgeons and patients will benefit from access to publicly reported information provided in a fair and understandable format.
- Patients, insurance companies, health care quality organizations, and the government desire transparent and accurate reporting of cardiothoracic surgery outcomes.
- Public reporting is the right thing to do, and STS regards this as a professional responsibility.
- Public reporting is one way to demonstrate the quality of cardiothoracic surgery, as well as a commitment to transparency.
- Outcomes reports based on clinical data are more accurate and more useful than are outcomes reports based on administrative data, which lack critical clinical information about patients.
What is a quality performance measure?
A quality performance measure is a numeric calculation of health care quality that can be used to monitor, assess, and improve the quality of patient care.
When are ACSD, CHSD, and/or GTSD data posted on the STS website?
ACSD public reporting data are updated twice per year (January and late July/early August). CHSD and GTSD public reporting data are updated once per year (summer, late July/early August).
**Due to the challenges related to COVID-19, ACSD and GTSD data refreshes will not take place in summer 2020. The next data updates are expected in January 2021.**
How may we enroll in Public Reporting?
What is the importance of National Quality Forum-endorsed measures?
The National Quality Forum (NQF) is a nonprofit organization that conducts a rigorous, evidence-based review of quality performance measures for the purposes of granting endorsement of specific measures. NQF-endorsed measures are considered the gold standard for health care performance measurement and are recognized by the national health care community as “best in class,” evidence-based, and valid. NQF evaluates measures using five major criteria: importance to measure and report, scientific acceptability of measure properties, feasibility, usability and use, and comparison to related or competing measures.
The Society of Thoracic Surgeons continues to develop and maintain quality performance measures in all three cardiothoracic surgery subspecialties (adult cardiac, congenital, and general thoracic), and more than 30 of these measures have either been endorsed or are in the process of being considered for endorsement by NQF.
Is it okay to compare our hospital with another hospital?
While participants may compare their quality ratings with national aggregate data, it is not statistically appropriate to compare their results directly with those of another hospital or practice. Such comparisons, or any other false, inaccurate, or misleading uses of STS quality ratings, may lead to STS disciplinary action. In that regard, it should be noted that any or all of the surgeons composing the “Surgeon Participant” will be considered responsible for public uses of quality ratings data made by them, their group, or the hospital associated with their participation in the Database.
May we create our own three-star logo to use when promoting our three-star rating?
You may create your own three-star logo, but including The Society of Thoracic Surgeons’ name and/or incorporating the STS logo is not allowed. The STS National Database participant logo is available, free of charge, to promote active participation in the Database, including but not limited to STS public reporting initiatives. The logo is updated annually, and a current License Agreement is required for each calendar year.
Are there guidelines for participants regarding using quality ratings in press releases?
Participants are encouraged to publicize their own statistics and outcomes in comparison with the STS national mean or average as a benchmark assessment. STS also strongly advocates publicizing of sustained trends over time rather than “snapshots” that may be misleading.
In keeping with this policy, participants may publicize their quality ratings if they are based on data covering at least 1 year. The inclusive dates of data collection must be specified prominently in conjunction with the rating. While participants may compare their quality ratings with national aggregate data, they must not make direct comparisons with other hospitals or practices.
For additional details, read the STS Policy Statement on Public Dissemination of Quality Ratings.
What is coronary artery bypass grafting (CABG) surgery?
CABG (often pronounced “cabbage”) is the most commonly performed heart operation in the US. The operation is designed to bypass blockages in the patient’s coronary arteries in order to restore normal or near normal bloodflow to the entire heart during rest and exercise. Though an occasional patient needs only one bypass graft, most people who are candidates for CABG have blockages in several of their coronary arteries and need between three and five bypass grafts.
The surgeon will take a healthy blood vessel (artery or vein from the patient’s body), usually from the leg, arm, chest or abdomen, and use it to “bypass,” or go around, the diseased or blocked portion of the coronary artery, creating a new path for bloodflow to the heart.
What is aortic valve replacement (AVR) surgery?
Aortic valve replacement is a procedure performed by a cardiothoracic surgeon during which a patient’s failing aortic valve is replaced with a mechanical or biological heart valve. The aortic valve can be affected by a range of diseases, as well as by the normal aging process. As a result, the valve can either become leaky (aortic regurgitation) or partially blocked (aortic stenosis).
What is congenital heart disease?
Pediatric heart disease is a term used to describe a variety of heart conditions in newborns, infants, and children. The most common type of pediatric heart disease is congenital, meaning that children are born with it. According to the American Heart Association, congenital heart defects are the most common type of birth defect. They affect 8 out of every 1,000 newborns. Each year, more than 35,000 babies in the US are born with congenital heart defects.
The information included in this section was last updated December 2020.