This summer, I hope everyone found find time to escape the record-breaking heat while spending quality time with family and friends. Recently, while driving to the beach with my family and thinking about what to write for this column, I was surfing the satellite radio channels and was inspired by the title of the 1986 Janet Jackson song, “What Have You Done for Me Lately?” My mission for my day at the beach was clear: Update STS members on the Society’s exciting accomplishments, ongoing projects, and future plans that will directly benefit each one.
Strengthening the STS National Database
In the last President’s Column, I talked about the power of the STS Database and its impact on the specialty. Combined, the four registries of the STS National Database ─ adult cardiac surgery, general thoracic surgery, congenital heart surgery, and STS-Intermacs ─ have accurate, patient-level data on nearly 10 million cardiothoracic surgery operations. STS data along with research trials have been used to develop numerous clinical practice guidelines. Risk calculators are available to help assess the suitability for surgery in patients. Over the last three decades, risk-adjusted data has improved the safety of care, and 30-day outcomes of countless patients.
We now have the ability and opportunity to link our vast data with the National Death Index and with Medicare claims data to demonstrate long-term efficacy, comparative effectiveness, and value-based care compared with other interventional treatments. Over the next six months, we will publish sentinel papers with long-term outcomes on hundreds of thousands of patients demonstrating the efficacy of surgery on specific topics of adult cardiac surgery, general thoracic surgery, congenital heart surgery, and mechanical circulatory support devices. The first sentinel manuscript, which includes more than one million coronary artery bypass grafting patients from our database, demonstrates the long-term survival benefit of multi-arterial grafting and has been submitted to a high-impact journal.
That said, the STS Database is not perfect. Our users have helped to identify gaps and shortcomings as the Database has evolved from its original purpose to provide individual surgeons with tools to benchmark their program’s quality assessment and performance improvement.
Members have asked if the purpose of the database has changed to one of research for the benefit of some academic surgeons rather than serving as a patient care and quality assurance tool for all surgeons. Some members have noted that data collection has become too labor intensive because of the many data elements. Others have complained about the added expense due to abstractors, data coordinators, and third-party vendors needed to manage the data. There continue to be questions about the risk modeling and the relevance of the reported index cases given the rapidly evolving surgical practices related to the increase in transcatheter, endovascular, and endoscopic procedures, and novel drug therapies.
STS has been listening to this valuable member input, and we have made several changes to decrease the burden, lower the costs, and improve the efficiency of data reporting and return. We recently changed the data warehousing from Duke Clinical Research Institute (DCRI) to IQVIA. We moved most of the data analytics from DCRI to the STS Research Center, which will improve the efficiency and near real-time reporting, analysis, and return of program data. More than 10% of programs are using direct data entry to IQVIA, which allows these programs to bypass the need (and the cost) for third-party data vendors.
Moreover, we are modifying our data dashboard to improve its intuitive appearance and make it more user-friendly. Our goal is to encourage further engagement among surgeons and data coordinators and our STS staff are available to help train more people in direct data entry.
The STS Next Generation Risk Calculator
The STS recently launched a next-generation Operative Risk Calculator to assess the risk of adult cardiac surgery operations. This improved bedside patient care tool includes current risk model adjustment calibrated every three months to ensure up-to-date risk assessment for patients. In addition to the risk of mortality, the risk calculator also provides procedure-specific risk of individual complications associated with index operations (CABG, AVR, MVR, MV repair including one specifically for repair of primary MR, AVR-CABG, MVR-CABG, and MV repair-CABG), as well as the soon to be reported multi-valve and aortic procedures.
The new risk calculator includes recently added risk factors, such as liver disease, concomitant tricuspid valve procedure, NYHA class, and others not previously included. In addition to providing the calculated risks of individual complications and mortality, the risk calculator also updates and records the impact of each specific risk factor responsible for the composite risk scores to facilitate patient discussions, pre-operative optimization, and medical record charting. A summary page can be easily copied into the electronic medical record. The user-friendly risk calculator is viewable on an intuitively easy-to-use single computer screen and is available on most mobile devices.
With all the new changes, one constant remains: STS’s commitment to ensure that the database exists for all CT surgeons, not just selected large academic centers. The STS database captures 98% of all cardiac surgery operations performed in the United States, allowing every program of every size to benchmark data with the outcomes of “like institutions,” as well as the entire STS cohort.
We have been collecting and analyzing data on the evolving practice of cardiac surgery and will soon be reporting outcomes of multiple-valve operations with and without coronary artery surgery, as well as proximal aortic surgery, including aortic root procedures.
2024 Strategy and Planning
The STS Board of Directors, Council Chairs, and senior staff recently completed a strategic planning process. In this post-COVID world, much has changed in our profession, our specialty, and our membership. A new strategic plan is essential to reaffirm our mission and to set the STS’s top priorities and objectives for the next five years.
As you know, the STS is committed to championing the value and impact of the specialty through quality and research initiatives, advocacy, and strategic partnership. We also are steadfast in our commitment to advance the health, well-being, and inclusion of all CT surgeons from medical school through retirement. But we can’t do it alone. We must do it together.
As part of the 2024 planning process, STS commissioned a survey to collect member feedback, ideas, and insights that will help us explore new ways to enhance membership value, advocate for the specialty and deliver quality educational experiences.
Based on your feedback, we have initiated efforts to address concerns regarding inclusion, selection of STS leaders, and surgeon compensation disparities.
We hired an external consultant to evaluate STS’s DEI policies. I created two new Presidential Task Forces: The Nominating Committee Advisory Task Force to review and improve the current process for identifying, mentoring, and nominating senior STS leaders; and The Surgeon Compensation Task Force to create an annual cardiothoracic surgeon survey to help us better understand workplace-related compensation issues and negotiation matters. The regional, subspecialty, and practice-type specific salary/benefits data will be available to better equip cardiothoracic surgeons to advocate for themselves during contracting and salary negotiations.
STS's Reach Is Extraordinary
STS is everywhere we need it to be to help advance this specialty. The Annals of Thoracic Surgery is the most widely read CT surgery journal in the world. The Thoracic Surgery Foundation, STS’s philanthropic arm, has awarded $1 million in educational, research, and outreach grants in the past year. STS Advocacy is making unprecedented progress to represent your voice in Washington, DC.
As president of the STS, I recently was invited to testify on the value of medical registries at the U.S. House of Representatives Subcommittee on Health regarding Medicare coverage pathways for innovative drugs, medical devices, and technology. Of all the witnesses testifying at this hearing, the STS was one of only two medical specialty societies invited. The impact of our database and the effectiveness of our advocacy efforts literally give the STS a seat at the table in Washington, DC.
After spending the afternoon at the beach, my family and I packed up the car and started to drive back to our hotel. It was a great day at the beach. As luck would have it, the 1974 Bachman-Turner Overdrive song “You Ain’t Seen Nothin’ Yet” came on the radio as we pulled out of the beach parking lot. In one day, two classic rock song titles have proven to be an inspiration to help me write this article. What an exciting time to be a CT surgeon and a member of the STS!
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