Introduction to the STS National Database Series Jeffrey P. Jacobs, MD, David M. Shahian, MD, Richard L. Prager, MD, Fred H. Edwards, MD, Donna McDonald, RN, MPH, Jane M. Han, MSW, Richard S. D'Agostino, MD, Marshall L. Jacobs, MD, Benjamin D. Kozower, MD, Vinay Badhwar, MD, Vinod H. Thourani, MD, Henning A. Gaissert, MD, Felix G. Fernandez, MD, Cam Wright, MD, James I. Fann, MD, Gaetano Paone, MD, Juan A. Sanchez, MD, Joseph C. Cleveland, MD, J. Matthew Brennan, MD, Rachel S. Dokholyan, MPH, Sean M. O’Brien, PhD, Eric D. Peterson, MD, MPH, Frederick L. Grover, MD, G. Alexander Patterson, MD  The Annals of Thoracic Surgery  Volume 100, Issue 6, Pages 1992-2000 (December 2015) DOI: 10.1016/j.athoracsur.2015.10.060 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Increasing center level penetration in The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD). This graph only provides data through 2012 because, at the time this article was written, 2012 was the last year of available linked data from the linkage of STS ACSD and the Centers for Medicare and Medicaid (CMS) Medicare database. Linkage for 2013 data is now under way and will likely show continued increasing penetration [3]. (The data in this graph is derived from the following article that is in press: Jacobs JP, Shahian DM, He X, et al. Penetration, completeness, and representativeness of the STS database. Ann Thorac Surg 2016;101, by permission of Elsevier.) The Annals of Thoracic Surgery 2015 100, 1992-2000DOI: (10.1016/j.athoracsur.2015.10.060) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Annual growth of The Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database by number of participating centers submitting data. The aggregate feedback report from Spring 2015 harvest of the STS Congenital Heart Surgery Database includes data from 116 North American congenital database participants representing 127 congenital heart surgery hospitals in North America, 124 in the United States and 3 in Canada. The Annals of Thoracic Surgery 2015 100, 1992-2000DOI: (10.1016/j.athoracsur.2015.10.060) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Increasing participation in The Society of Thoracic Surgeons (STS) General Thoracic Surgery Database. (A) Participating centers. (B) Participating surgeons. Note: number of surgeons counts surgeon/participant pairs; if a single surgeon is associated with more than one participant, he or she is counted more than once in this total. The Annals of Thoracic Surgery 2015 100, 1992-2000DOI: (10.1016/j.athoracsur.2015.10.060) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Organizational chart for The Society of Thoracic Surgeons (STS) Council on Quality, Research, and Patient Safety. (TF = Task Force; WF = Workforce.) The Annals of Thoracic Surgery 2015 100, 1992-2000DOI: (10.1016/j.athoracsur.2015.10.060) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Observed and expected mortality rates, observed to expected (O/E) ratios, and prevalence of six major risk factors, by quarter, 2004 to 2014, in the STS Adult Cardiac Surgery Database [7]. (Republished from Shahian DM, Grover FL, Prager RL, et al. The Society of Thoracic Surgeons voluntary public reporting initiative: the first 4 years. Ann Surg 2015;262, by permission of Wolters Klower Health; permission conveyed through Copyright Clearance Center, Inc.) The Annals of Thoracic Surgery 2015 100, 1992-2000DOI: (10.1016/j.athoracsur.2015.10.060) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 (A) Estimated adjusted odds ratios for in-hospital mortality by week of gestational age at birth (reference, 39.5 weeks) and piecewise 95% confidence intervals (shaded area) [8]. (B) Estimated adjusted ratios of medians of postoperative length of stay (reference, 39.5 weeks) and piecewise 95% confidence intervals (shaded area) [8]. (Republished from Costello JM, Pasquali SK, Jacobs JP, et al. Gestational age at birth and outcomes after neonatal cardiac surgery: an analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database. Circulation 2014;129:2511–7, by permission of Wolters Klower Health.) The Annals of Thoracic Surgery 2015 100, 1992-2000DOI: (10.1016/j.athoracsur.2015.10.060) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 (A) The standardized incidence ratio of mortality or major morbidity after lung cancer resection among The Society of Thoracic Surgeons (STS) participating sites [9]. (Reprinted from Kozower BD, Sheng S, O'Brien SM, et al. STS database risk models: predictors of mortality and major morbidity for lung cancer resection. Ann Thorac Surg 2010;90, by permission of Elsevier.) (B) Risk-adjusted rates of morbidity after esophagectomy for cancer among STS participating sites [10]. (Reprinted from Wright CD, Kucharczuk JC, O'Brien SM, et al. Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model. J Thorac Cardiovasc Surg 2009;137, by permission of Elsevier.) The Annals of Thoracic Surgery 2015 100, 1992-2000DOI: (10.1016/j.athoracsur.2015.10.060) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions