STS National Database Frequently Asked Questions and Answers

STS has provided answers to frequently asked questions regarding STS National Database data collection. New Q&As will be added every other month.

Adult Cardiac Surgery

Sequence #: 2290
Short Name: AbxDisc
Long Name: Appropriate Antibiotic Discontinuation

Question: A patient with renal insufficiency had their postoperative antibiotic frequency changed from every 8 hours x 5 doses to every 12 hours x 5 doses. This times the last dose beyond the 48-hour limit. Would change for renal insufficiency be a permitted exclusion? 
Answer: No, renal insufficiency is not an exclusion. They should still keep the 48-hour limit as long as there is no other reason for continuation of antibiotic treatment. This is related to clearance, and the drug is still circulating related to poor renal function. 

Sequence #: 2155 
Short Name: OpONCard 
Long Name: Other Non-Card 
Definition: Indicate whether a non-cardiac procedure was done.

Question: How would I code a severe pectus excavatum repair performed during CABG/AVR replacement procedure?
Answer: Code as CAB/AVR and other, non-cardiac.

Sequence #: 6750 
Short Name: Complics 
Long Name: In Hospital Post-Op Events 
Definition: Indicate whether a postoperative event occurred during the hospitalization for surgery. This includes the entire postoperative period up to discharge, even if over 30 days.

Question: The patient had the following postoperative complications: thrombocytopenia, hemolytic anemia, AKI, AMS, possible thrombotic microangiopathy. Differential diagnoses included TTP, HUS, DITMA, and HUS. No DIC. The patient ultimately required plasmapheresis. How is the plasmapheresis captured? 
Answer: Plasmapheresis is not captured as a postoperative event. 

Sequence #: 1030 
Short Name: MedBeta 
Long Name: Meds-Beta Blockers Within 24 Hours 

Question: Should it be considered a contraindication if the patient has a hold order for a beta blocker for a heart rate less than 55 and the nurse holds the medication for this reason? 
Answer: Yes, this is a contraindication since the order was appropriately followed as written. 

Sequence #: 1685
Short Name: VDMit
Long Name: VD-Mitral

Question: A patient had a previous surgical mitral valve replacement and then returned for an AVR. The prosthetic mitral valve was functioning normally. Do I code the mitral valve as diseased?
Answer: No, the valve is not considered diseased.

Sequence #: 6550
Short Name: PostOpPeakGlu
Long Name: Postoperative Peak Glucose

Question: Which blood glucose level should be captured as the peak value? 

Anesthesia End Time: 02/20/2018 @ 1200
18-24 post Anesthesia End Time: 02/21/2018 0600-1200
Glucose Readings:
2/21 @ 0630 – 154
2/21 @ 0730 – 123
2/21 @ 0830 – 115
2/21 @ 0930 – 132
2/21 @ 1030 – 147
2/21 @ 1130 – 138
2/21 @ 1230 – 156

Answer: The value from 2/21 @ 0630 of 154 is the value to be recorded as the peak glucose value 18-24 hours post anesthesia end time. 

Sequence #: 6735
Short Name: WoundIntVac
Long Name: Post-Op-Wound Intervention - Wound Vac 

Question: Our site is putting in wound vacs for prophylactic use to aid with wound healing. The only way to capture the use of a wound vac is to answer ‘yes’ to Surgical Site Infection (SurSInf 6690) and ‘yes’ to Wound Intervention (WoundInter 6725). However, the patient did not have an infection so this would be incorrect. How do I capture the use of these wound vacs?
Answer: Prophylactic wound vacs are not to be captured. Do not code infection or wound intervention or wound VAC for these cases. If the patient develops a wound infection and the wound vac is used for this purpose, then you would code the infection appropriately.

Sequence #s: 810 & 945
810: Long Name: Previous Other Cardiac Intervention 1; Short Name: POCInt1 
945: Long Name: Cardiac Arrhythmia; Short Name: Arrhythmia
Question: I have a patient who has Wolff-Parkinson-White Syndrome. She had an ablation and cardioversion because of this arrhythmia. How do the previous procedures and arrhythmia sections get coded?
Answer: Depending on the previous procedure, code the procedure for Wolff-Parkinson-White (WPW) syndrome as ablation, catheter, other, or unknown in sequence 810 (Previous Other Cardiac Intervention). Do not code WPW as an arrhythmia in sequence 945 (Cardiac Arrhythmia).

Question: In the OR, after a radial graft harvest, the surgeon writes this: "At this point, there was some concern about the radial artery, not having any backflow after the tourniquet was down, the upper arm was then opened and the hand appeared to have capillary refill; however, a decision was made to freely mobilize proximally the radial artery as well as distally and re-anastomosed using 7-0 Prolene in running fashion. Hemostasis was achieved and the wound packed. Vascular Surgery was consulted." Is this considered an “other non-cardiac vascular procedure?”
Answer: Do not code the radial graft harvest or re-anastomosis, as this is part of the CAB procedure. Do not code as a surgical complication; however, code any postoperative complications affiliated with the radial artery harvest.

Sequence #: 675
Short Name: PrValve
Question: During a transcatheter mitral clip procedure, the physician was unable to grasp the leaflets, so the procedure was aborted and the patient underwent a surgical MVR during the same episode of care. How should the previous percutaneous mitral valve procedure in this case be captured?
Answer: You should not capture the percutaneous mitral clip procedure as a previous CV intervention since it was not deployed.

Sequence #: 6950
Short Name: COtOther
Question: A patient had a cath followed by a CABG during the same episode of care. A pseudoaneurysm developed at the cath site requiring thrombin injection and delaying discharge. Should this be captured as a complication?
Answer: No, do not capture this as a complication of the CABG procedure.

Sequence #: 7001
Short Name: Mt30Stat
Question: If the patient is placed on palliative care, end of life care, or hospice post-surgery, does it change the mortality?
Answer: No. If the patient expired, this would still count as a 30-day mortality.

General Thoracic Surgery

Version 2.41

Sequence #: 3920
Long Name: On Oxygen at 30 Days PostOp
Question: If a follow-up note states that the patient is on room air but uses supplemental oxygen, do we code this as "Yes"?
Answer: Yes.

Sequence #: 3930
Long Name: Readmission within 30 days of Discharge
Question: A patient who underwent thoracic surgery at our facility was transferred to another acute care facility on November 30 for lung transplant evaluation (service not provided at our facility), but was not a candidate and was transferred back to us on December 6. Please advise if the following dates are correct: Discharge date for the index surgery is November 30 as the transfer to the other acute care facility created a new account number. Readmission at 30 days is "no" as he remained in an extension of acute care hospital stay the entire time.
Answer: This is not a readmission, as the patient was not discharged to home or an extended care facility.  

Sequence #: 830
Long Name: PreOp Medical History - Chronic Immunosuppressive Therapy
Question: If a patient had a splenectomy, should sequence # 830 be answered as "yes"? He is not on therapy, but he is still considered immunocompromised.
Answer: This is strictly medically immunocompromised (immunosuppression) or HIV.

Sequence #: 770
Long Name: Prior CT Surgery
Question: The patient had a Laparoscopic Hernia Repair 43281 and returns for a reop. I have answered yes to Seq770 for a prior VATS, but need clarification on Seq780 as there is no laterality given in the chart.
Answer: Laparoscopic surgery is not the same as a VATS procedure. In this case, indicate ‘No’ to Seq. 770, then indicate ‘yes’ on Seq. 1410.

Sequence #: 1070
Long Name: ECOG Score
Question: When abstracting for this field, does there have to be specific documentation of an ECOG score from the provider, or can the abstractor use information in the medical record to assign a score?
Answer: It should be documented in the medical record.

Sequence #: 1580  
Long Name: Lung Cancer
Question: A patient is treated for a spontaneous pneumothorax with a blebectomy (32655). His pathology report returns positive for invasive adenocarcinoma. In this case, lung cancer was never suspected. Should this code be amended to a therapeutic wedge so that this case is analyzed? Should I check the known or suspected lung cancer box? Should clinical staging and pathology fields be completed?
Answer: A lung resection was done. Indicate ‘Yes’ to 1580 and ‘No’ to 1630 and 1660.

Sequence #: 2950
Long Name: Esophagitis - LA Grade
Question: If esophagitis is graded as A to B during an EGD, do I pick A or B for the final grade?
Answer: Indicate B as it is the higher grade.

Sequence #: 710
Short Field Name: PreopChemoCurWhen
Question: The title of the data element says "Current Malignancy." However, the definition states "Indicate when the patient received preoperative chemotherapy and for what disease." Responses include two options for unrelated disease. Please clarify whether we should only consider the current thoracic malignancy for this data element, or whether "Current Malignancy" is an inadvertent carry-over from v2.3.
Answer: The title "Current Malignancy" is wrong; if the patient had chemo for an unrelated disease, we want to capture that.

Sequence #: 3040
Short Field Name: ImageType
Question: For hiatal hernias, does imaging performed include an EGD for barium swallow/upper GI choice?
Answer: Imaging does NOT include EGD. EGD will be added to the next version.

Sequence #: 1970
Short Field Name: LungCAHist
Question: How do we collect large cell neuroendocrine carcinoma in version 2.41? The option was available in 2.3 as high grade neuroendocrine, but there is no option for high grade neuroendocrine with the new version.
Answer: Mark "Large Cell" in Histology, and then in the Grade section, mark "High Grade."

Sequence #: 2430
Short Field Name: PathRptStage
Question: If a patient has "no thymoma," there is no option to indicate that for this question, so it will just come as a missing variable.
Answer: This case is not collected. If the patient does not have a thymoma, do not capture the case.

Sequence #: 1500
Short Field Name: Primary
Question: For the upcoming new version 2.41, I see that Therapeutic Wedge Resections are analyzed (like old version), but the heading says "Lung Cancer Resection." Should I ONLY be collecting the cases that the Pathology came back with a diagnosis of Lung Cancer? The reason why I'm asking this is because I'm currently collecting Therapeutic Wedges that don't always come back as Lung Cancer on Path. The surgeon had "intent" on treating a "suspicious opacity."
Answer: No, the DCF is completed for all suspicious cases, not just those that come back positive for lung cancer. For suspicious lung cancer cases that come back negative for lung cancer on the final pathology report, complete the Lung Cancer Clinical Staging section on the DCF, then in the Final Pathology Staging section, check “No cancer found, benign tumor” for Lung Cancer Result, Seq. #1910.

Sequence #: 970
Short Field Name: CigSmoking
Question: This is actually a question that pertains to version 2.41. Where is the correct place to document marijuana use? The data dictionary states that it should not be coded under cigarette smoking, but in version 2.41 in the definition for field 1000 - Narcotic Dependence, other illegal substances are listed but not marijuana. Medical marijuana is not legal in my state, but we have many patients who smoke it illegally.
Answer: Marijuana use is not captured.

Version 2.3

Sequence #: 923
Short Field Name: ClinStagLungNeedle
Long Name: Clinical Staging Method - Lung – Needle Biopsy
Question: Should #923 (ClinStageLungNeedle) be coded as 'Yes' if a biopsy is performed during an EBUS?  
Answer: Code only the EBUS.

Sequence #: 271
Long Name: Date of Last Follow-Up
Short Name: LFUDate
Definition: Indicate the date on which the last follow-up was made. If patient dies in the hospital, this value will be the same as the date of death. If no follow-up is made after patient is discharged, this value will be the same as the discharge date.
Question: For readmission, it is understood to use the date of discharge as the last follow-up. For the status for 30-day, 1-year, and 5-year survival, is it correct to count from the date of surgery?
Answer: Yes, use the date of surgery for your follow-up date.

Question: Patient has an esophagectomy. Postop leak with pleural effusion. Antibiotics started, NPO, CT placed draining bilious fluid, no fever, no increase in WBC. Pleural fluid with positive culture. I captured #1950 anastomotic leak for postop complication. Would you also capture #2060 for Organ space SSI, or is infection part of Leak sequela?
Answer: The infection is part of the leak. Just capture the leak.

Sequence #: 1800
Short Name: RespFail
Question: For a patient who met basic indicators for the Resp Failure post-comp (per blood gases and MD documentation of postop resp failure, but who was not reintubated), which was expected due to the severity of the patient’s pre-existing illness and indications for surgery and who was made DNR several weeks after the initial surgery, is this an appropriate application of the Resp Failure complication/event?
Answer: No, the patient was not reintubated.

Sequence #: 1720
Short Name: ReturnOR
Question: Patient’s original surgery was open thymectomy. Six days later, the patient underwent sternal debridement, rib plating, and pectoral muscle flap due to sternal dehiscence. The patient was not discharged in between surgical cases. Is this considered other events requiring surgery, or should it be entered as a new thoracic case?
Answer: This would be collected on a new data collection form. It also would be a postop event on the original surgery. It would be Unexpected Return to the OR (#1720), not Other Events Requiring Surgery (#2170), since it is during the initial hospitalization.

Congenital Heart Surgery

Version 3.41

Sequence #: 4280
Short Field Name: ReadmitDt
Question: A patient was originally discharged on October 4, 2018, and reported to the local emergency department for desaturations on October 13. The patient was transferred and directly admitted to our facility at that time, kept overnight as an inpatient, and then discharged the following morning. On October 22, the patient admitted for incisional infection and was discharged again on October 25. I can only code one readmission. How should I code this? 
Answer: The best you can do is code the first readmission. You just don’t code the second readmission. Capture the readmission closest to surgery.

Sequence #: 1087
Short Field Name: Planned ReOp
Question: A patient was born at our hospital with multiple cardiac anomalies, including coarctation of the aorta and ventricular septal defect (VSD). The patient had coarctation repair done first, and then at a later date within the same admission, had the VSD closed. Is the VSD closure considered a planned reop or unplanned?
Answer: It depends on the initial surgical plan prior to the coarctation of the aorta repair. Some centers initially plan a staged repair. If the plan was to do the repair in stages, then it is a planned reop.

Sequence #: 4200 - 72
Short Field Name: Arrhythmia Requiring Drug Therapy
Question: Should electrolyte replacement for arrhythmia correction be included here?
Answer: No.

Sequence #: 850
Short Field Name: PreOp Factor – Non-invasive respiratory support
Question: The new preop factor of "non-invasive respiratory support to treat cardiorespiratory failure" does not have a definition associated with it. Does this mean any type of non-invasive support? Is this at the time of OR entry or any time during the hospitalization, as is the case for mechanical ventilator support?
Answer: The timeframe of any time during the hospitalization should be applied. Non-invasive respiratory support should be administered through a ventilator support machine (i.e., CPAP, BiPAP) without the presence of an endotracheal tube or tracheostomy tube. This does not include high-flow nasal cannula. If the support is just for transport, it does not count.

Question: For sequence 1080, if a patient has a BiVAD placed with a subsequent transplant done in the same admission, is the transplant considered a planned or unplanned reoperation? Also, do I code the transplant as an unplanned reop in the BiVAD "complications?"
Answer: The subsequent heart transplant to the BiVAD placement should be coded as planned. If the BiVAD was inserted prior to the index case, do not code any complications, but include the BiVAD as a preoperative factor if the patient was still supported with the BiVAD at OR entry date and time for the transplant.

Question: I have some cases where the patient developed a femoral artery thrombus from a central line and was treated for 6 weeks with Lovenox. How would I capture this in the complications field? Would it be wrong to put it as thrombus, peripheral deep vein? The only arterial options I see for thrombus are pulmonary artery thrombus.
Answer: There is no current way to code arterial thrombus, but it can be included under "other complication for use locally."

Question: Term newborn was noted to have murmur and tachypnea at 2 days old after circumcision. Transferred to NICU and diagnosed as HLHS. Cultures drawn, antibiotics started. Transferred to our hospital for surgery. Antibiotics continued, blood culture drawn on admission negative. Outside hospital notified us that blood culture final reading was positive 4 days of age. Antibiotics stopped after 72 hours. Infant was tachypneic and tachycardic within 48 hours of surgery. Provider states culture was slow growing and still growing when infant 7 days of age. WBC 13.6, platelets 250. Norwood performed at 9 days of age. Would this count as sepsis with positive culture? 
Answer: This does not represent sepsis with positive blood culture or sepsis. The culture was drawn before treatment, and the continued growth is not indicative of the patient’s status 48 hours before surgery.

Question: An earlier FAQ from April 2018 says: "What is the OpType for a 'Pacemaker, Removal, Permanent pulse generator'?" and you answered No CPB Cardiovascular. If the generator is epigastric and is replaced using the same wires as before, shouldn't that be Thoracic since they didn't touch the heart? Does placing or removing leads from the heart make it No CPB, or is anything pacemaker related considered No CPB? 
Answer: All pacemaker procedures are coded as No CPB Cardiovascular cases. 

Sequence #: 850
Short Field Name: PreopFactor
Question: The specs say to code coagulation disorders if the labs are appropriate at the time of OR entry. Is there a time range that this should include? We do not collect labs prior to OR entry for all patients (or between admission date/time and OR entry), but patients may have been seen in clinic prior to the OR or in the Coag Lab recently. How far back are these labs "valid"?
Answer: Currently, there is no definition for this in the data specifications. For now, code the coagulopathy if the lab values are present within 24 hours of entering the OR, as most patients who are actively being anticoagulated are instructed to stop their anticoagulant medications prior to surgery.

Sequence #: 900
Short Field Name: PrimDiag
Question: 290-TOF vs 2140-TOF, Pulmonary stenosis. Why do patients that have 290 as their diagnosis not show up as TOF patients in the DCRI report? We have been forced to change all patients diagnosis to TOF, PS if we want them included in our count of TOF patients. 
Answer: The type of TOF needs to be included for comparison purposes. TOF, PS should only be coded for those cases where that is the patient’s diagnosis. The table in the analysis report is only looking at one specific type of TOF and not looking at the other types to allow for comparison.

Sequence #: 4560
Long Name: Patient died or had major postoperative complication(s)
Short Name: PostOpComp
Definition: Indicate whether the patient died before hospital discharge and/or had any of these major postoperative complication(s): 

A. New postoperative renal failure requiring dialysis
B. New postoperative neurological deficit persisting at discharge
C. Arrhythmia necessitating permanent pacemaker insertion
D. Paralyzed diaphragm
E. Need for postoperative mechanical circulatory support
F. Unplanned reoperation and/or interventional cardiovascular catheterization procedure

Question: During a recent meeting, there was confusion about option F, "Unplanned reoperation." Should data managers consider only cardiac unplanned reoperations, or all unplanned reoperations? Many people argued that something like a g-tube surgery after an index operation should not be considered a major postoperative complication. Can you please clarify?  
Answer: Per the data specs, all unplanned reoperations are included as major postoperative complications, including g-tubes.

Question: A neonate with Shone’s Complex had an aortic arch repair on the sixth day of life. It was discovered after the surgery that the child had “Alveolar Capillary Dysplagia with misalignment of pulmonary veins.” This diagnosis carries a 100% mortality rate. Not surprisingly, the child died a few days after surgery. Because of the child’s poor prognosis, given his alveolar disease, this surgery was somewhat palliative in nature. Will this be counted in my hospital’s adjusted risk mortality calculation? In the past, my surgeon has done other palliative surgeries, and it was determined by STS to not affect the adjusted risk mortality calculation. If the above mentioned case is determined to not be included as a mortality included in the adjusted risk mortality calculation, how should I go about coding this?
Answer: This is a mortality that will be included in the risk-adjusted mortality calculation. We are not aware of other “palliative” procedures that do not count in the risk model other than those without STAT scores, operation types that are not CPB or No CPB Cardiovascular, or exceptions of PDA ligation in patients.

Sequence #: 1056
Short Name: OpType
Question: Patient had LVAD implantation, mitral and tricuspid valvuloplasty, and conduit replacement. Is this OpType VAD w/ CPB, or CPB cardiovascular?
Answer: This would be CPB cardiovascular.

Sequence #: 4200
Short Name: Complication
Question: A patient is having a hybrid procedure “stage 1,” application of RPA and LPA bands in the cath lab along with a cath procedure. During the procedure, the patient arrested and received CPR. Would this complication be coded as “unexpected cardiac arrest” or “complication of cardiac cath” procedure?
Answer: Unexpected cardiac arrest should be coded, as this was a cardiac surgery procedure.

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