ProHealth Heart and Vascular Care in Waukesha, Wis., embarked on a multidisciplinary initiative to reduce ventilation times for isolated Coronary Artery Bypass Grafting patients at Waukesha Memorial Hospital. The goals: Reduce the risk of patient harm associated with mechanical ventilation and achieve significant improvements in teamwork and safety culture.
In the realm of cardiovascular care, ensuring adherence to quality metrics is paramount for achieving better patient outcomes. But having a lot of data is not enough. Every healthcare professional who plays a role on an integrated patient care team needs to be aware of the data available to them, understand what it means, and act on that understanding. And that’s a challenge that exists across the health system.
STS is pleased to announce the release of the Adult Cardiac Surgery Database Executive Dashboard Report, now available on the Database platform. The Executive Dashboard includes the following components:
The participant’s star ratings for the last six star-rating periods, allowing you to easily track your site’s risk-adjusted performance longitudinally.
Resource utilization metrics for isolated coronary artery bypass grafting (CABG) procedures, which provide participants near real-time data vs. STS benchmark data from the previous analysis period, including:
ICU times
Postoperative total ventilation hours
Postoperative length of stay
Total blood project usage (intraoperative/postoperative)
Participant’s performance on meeting inclusion eligibility criteria. Utilizing green, yellow, and red statuses and convenient drill-down functionality, participants can easily identify cases of concern and save valuable time. And case counts are available to allow users to verify if their site meets case count requirements for analysis. Updates to this report are ongoing to provide real-time data. Refer to the Notifications tab on the IQVIA Platform for updates.
Additional procedure types for resource utilization metrics were released on April 13, 2024. More utilization metrics are being considered. If you have a suggestion, contact Carole Krohn at ckrohn@sts.org.
In this short video, STS members exchange viewpoints on a new study that found patients with postoperative PE had increased 30-day mortality, reintubation, and readmission rates, which was presented at the 2024 STS Annual Meeting.
Robbin Cohen, MD, Cedars-Sinai at Huntington Hospital, is joined by the study’s lead author, Andrea L. Axtell, MD, MPH, an assistant professor of surgery at the University of Wisconsin School of Medicine and Public Health, Michael Smith, MD, Norton Thoracic Institute, St. Joseph’s Hospital & Medical Center, and John Mitchell, MD, University of Colorado Health, to discuss the research methodology, findings and impact on improving patient care.
In the fast-paced environment of healthcare, hospitals face significant challenges related to medical records. The increasing number of missing documents in electronic medical records (EMR) can pose obstacles to case abstraction and risk adjustment. This case study reveals the EMR challenges Ascension Saint Thomas Hospital faced and the steps the data team took to improve document management and overall performance.
Boone Health, based in Columbia, Missouri, set out to address issues related to the appropriate discontinuation of antibiotics within 48 hours after cardiovascular surgery. This case study examines the obstacles, actions, and results led by an interdisciplinary team approach.
UC Davis Health, based in Sacramento, California, knew that implementing quality improvement measures required operational and clinical analytics to guide process development and care redesign efforts. This case study explains how the health system addressed clinical documentation challenges through better data, education, communication, and collaboration across disciplines and delivered better patient outcomes.
During this session, investigators unveiled findings from the largest multicenter study of post-arterial switch operations (ASO) that resulted in increased survival rates for adolescents and adult patients – as well as an increase in the potential for these patients to require cardiac reoperations to address arterial switch related complications that arise later in life.
At day two's presentation on “Burden of Reoperative Cardiac Surgery among Adolescents and Adults Who Have Undergone Prior Arterial Switch Operation: Society of Thoracic Surgeons Database Analysis,” Bret Mettler, MD, from Johns Hopkins University, examined a multi-year assessment of the prevalence and types of cardiac surgical interventions in patients who previously underwent ASO using data from the STS National Database.
“Anatomical repair of transposition of the great arteries (TGA) and related anomalies by arterial switch operation (ASO) achieves a normal anatomic and physiologic cardiac configuration,” said Dr. Mettler. “And as survival rates have increased, so have the potential for these patients to require cardiac reoperations to address resulting ASO-related complications.”
As most reoperations involved multiple procedures, the presentation examined how a hierarchical stratification of procedure categories was established, with each eligible surgical hospitalization assigned to the single highest applicable hierarchical category.
Dr. Mettler's presentation also examined implications for surgical counseling, post-operative clinical surveillance, and therapeutic management. An analysis of the role of procedural prevalence, timing, categories, trends, and the growing number of reoperations was discussed.
Shortly after the 60th STS Annual Meeting began, a packed crowd attended the "Trends and Research from the STS Adult Cardiac Surgery Database (ACSD)" session, beginning with a presentation by Michael E. Bowdish, MD, of the Smid Heart Institute, Cedars-Sinai Medical Center. He looked back at the origins of the ACSD, which was established in 1989 to collect information on cardiac surgery procedures, track outcomes, and provide insights into opportunities for quality improvement.
Expert panel members field questions during the "Trends and Research from the STS ACSD" session.
Today – more than three decades later – the Database offers more than nine million recorded procedures making it one of the most comprehensive, robust, and sophisticated contemporary clinical databases in use.
For example, 95% of centers performing coronary artery bypass grafting (CABG) in the United States, and 97% of patients receiving CABG are included in the STS ACSD. Every year 10% of the participating sites undergo a data audit assessing data accuracy and completeness with strict thresholds to pass quality control. Continuous education of data managers is a further element to ensure data quality.
"STS ACSD is a vital source of data for outcomes research quality improvement, with overall volumes that are stable with notable trends in aortic surgery," said Dr. Bowdish.
The STS ACSD has provided the foundation for national benchmarking in adult cardiac surgery through the development of regularly updated and recalibrated risk models and performance metrics, the availability of feedback reports to database participants and individual surgeons, quality-improvement efforts, voluntary public reporting, and comparative effectiveness research.
On day one of STS 2024, meeting goers attended numerous sessions that explored the growing debate between SAVR and TAVR as treatment options,
Dr. Michael Bowdish presents a late-breaking session on cardiac surgery after TAVR trends and outcomes.
"Improved Longitudinal Outcomes with Surgical Aortic Valve Replacement with Atrial Fibrillation Management over Transcatheter Aortic Valve Replacement Alone," part of the larger "Bring SAVR Back" session given by J Hunter Mehaffey, MD, unveiled Class I guideline recommendations that support atrial fibrillation (AF) treatment during surgical aortic valve replacement (SAVR). And how recently, many low to intermediate risk patients with AF and aortic stenosis (AS) are managed by transcatheter aortic valve replacement (TAVR). And finally, they evaluated real-world longitudinal outcomes of TAVR vs SAVR with or without AF treatment.
"We concluded that in Medicare beneficiaries with AF who required aortic valve replacement, SAVR with concomitant treatment of AF was associated with improved longitudinal survival and freedom from stroke compared to TAVR," noted Dr. Mehaffey. "Consideration should be given for SAVR with AF treatment as a first-line approach for patients with AF requiring aortic valve replacement."
In his discussion of "Robotic Aortic Valve Replacement versus Transcatheter Aortic Valve Replacement: A Propensity Matched Analysis," Vikrant Jagadeesan, MD, presented findings on contemporary data that supports equipoise between surgical aortic valve replacement and transcatheter aortic valve replacement (TAVR) for the management of symptomatic severe aortic stenosis (AS). He further explained that controversy exists around the optimal management of patients in low to intermediate risk categories, and how the study compared outcomes of surgical robotic aortic valve replacement (RAVR) to TAVR.
"Compared to TAVR, RAVR was associated with lower stroke and PPM rates, less PVL, and improved 1 year survival," said Dr. Jagadeesan. "And RAVR may provide a safe and effective minimally invasive first-line alternative for low to intermediate risk patients presenting with symptomatic AS."
In a late breaking session titled, "Cardiac Surgery after Transcatheter Aortic Valve Replacement: Trends and Outcomes," Michael Bowdish, MD, illustrated how his research team set out to document trends and outcomes in cardiac surgery following transcatheter aortic valve replacement (TAVR), a topic gaining importance as reports of subsequent cardiac operations and early TAVR explantations increase. Using the Society of Thoracic Surgeons Adult Cardiac Surgery Database, the study covers adult patients who underwent cardiac surgery after an initial TAVR from January 2012 to March 2023.
"The study findings underscore the escalating need for both aortic and non-aortic valve cardiac surgeries following TAVR," explained Dr. Bowdish. "They note a substantial increase in the frequency of these surgeries, emphasizing the importance of understanding outcomes." He observed elevated risk in these cases, as indicated by mortality and stroke rates, which calls for careful consideration, particularly given the expanding use of TAVR across a broader range of age and risk profiles. Finally, the study suggests the need for ongoing assessment and longitudinal evidence to inform decision-making in the evolving landscape of TAVR applications.
On Saturday, January 27 at 9:45 a.m. CT, Christopher Mehta, MD, from Northwestern Memorial Hospital in Chicago, will present “Age-Stratified Surgical Aortic Valve Replacement for Aortic Stenosis: An Analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database (ACSD).”
During his talk, Dr. Christopher Mehta will provide insight into how comprehensive data helps inform multidisciplinary heart teams in making decisions for patients.
The study is part of the STS 2024 session titled, “Trends and Research from the STS ACSD.” During his talk, Dr. Mehta will provide insight into how comprehensive data help inform multidisciplinary heart teams in making decisions between surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) for patients.
Attendees will learn how the national landscape for SAVR and TAVR changed between 2011 and 2022, as experts evaluated age-specific trends and outcomes in surgical aortic valve replacement (AVR) in patients with bicuspid (BAV) or tricuspid (TAV) aortic valve by analyzing data from the STS ACSD.
Throughout the 11-year study, which followed more than 200,000 adult patients with BAV or TAV who underwent AVR for moderate and severe aortic stenosis, age-specific trends and outcomes were evaluated.
