The STS National Database: current changes and challenges for the new millennium T.Bruce Ferguson, MD, Stanley W Dziuban, MD, Fred H Edwards, MD, Mary.

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The STS National Database: current changes and challenges for the new millennium T.Bruce Ferguson, MD, Stanley W Dziuban, MD, Fred H Edwards, MD, Mary C Eiken, MS, A.Laurie W Shroyer, PhD, Peter C Pairolero, MD, Richard P Anderson, MD, Frederick L Grover, MD The Annals of Thoracic Surgery Volume 69, Issue 3, Pages 680-691 (March 2000) DOI: 10.1016/S0003-4975(99)01538-6

Fig 1 Increasing reporting sites by year in the STS National Cardiac Surgical Database, 1990 to 1997. Reprinted, with permission, from The Society of Thoracic Surgeons [5]. The Annals of Thoracic Surgery 2000 69, 680-691DOI: (10.1016/S0003-4975(99)01538-6)

Fig 2 Summary of all procedures performed by operation from 1990 to 1997 in the United States (N = 1,074,689). The number of coronary artery bypass (CAB) graftings is more than 800,000. (AVR = aortic valve replacement; MVR = mitral valve replacement.) Reprinted, with permission, from The Society of Thoracic Surgeons [5]. The Annals of Thoracic Surgery 2000 69, 680-691DOI: (10.1016/S0003-4975(99)01538-6)

Fig 3 Unadjusted mortality by procedure from 1990 to 1997 in the United States (N = 1,074,689). (AVR = aortic valve replacement; CAB = coronary artery bypass (grafting); MVR = mitral valve replacement.) Reprinted, with permission, from The Society of Thoracic Surgeons [5]. The Annals of Thoracic Surgery 2000 69, 680-691DOI: (10.1016/S0003-4975(99)01538-6)

Fig 4 Decline in the observed-to-expected mortality ratio calculated from the annual risk model for coronary artery bypass grafting, by year, in the United States (N = 810,998). (Exp = expected; Obs = observed.) Reprinted, with permission, from The Society of Thoracic Surgeons [5]. The Annals of Thoracic Surgery 2000 69, 680-691DOI: (10.1016/S0003-4975(99)01538-6)

Fig 5 Difference in operative mortality for coronary artery bypass grafting, by gender, normalized for body surface area, in the United States (N = 174,806). (Data from Edwards et al [8].) The Annals of Thoracic Surgery 2000 69, 680-691DOI: (10.1016/S0003-4975(99)01538-6)

Fig 6 Decrease in postoperative length of stay after primary coronary artery bypass grafting, by year, in the National Database. Note that length of stay decreased from 8 to 5 days over 7 years. (CI = confidence interval.) Reprinted, with permission, from The Society of Thoracic Surgeons [5]. The Annals of Thoracic Surgery 2000 69, 680-691DOI: (10.1016/S0003-4975(99)01538-6)

Fig 7 Increase in the use of the internal mammary artery in primary coronary artery bypass grafting, by year, in the National Database (N = 740,383). Reprinted, with permission, from The Society of Thoracic Surgeons [5]. The Annals of Thoracic Surgery 2000 69, 680-691DOI: (10.1016/S0003-4975(99)01538-6)

Fig 8 Reorganization of the STS Adult Cardiac Database Structure into Core and Extended Data Sets. The original 512 STS fields were separated and reconfigured into 217 Core fields and 255 Extended fields. Eighty-five original fields were deleted. Custom fields can be created using the new vendor software certified by the STS. The Annals of Thoracic Surgery 2000 69, 680-691DOI: (10.1016/S0003-4975(99)01538-6)

Fig 9 Data completion requirements indicating the number of data elements for different clinical procedures. (A) Modular data completion breakdown; 106 elements are common for all cases. (B) Examples of data requirements for common cases. Note that the number of fields contained in the majority of records has been reduced substantially. (ASD = atrial septal defect; CABG = coronary artery bypass grafting.) The Annals of Thoracic Surgery 2000 69, 680-691DOI: (10.1016/S0003-4975(99)01538-6)

Fig 10 (A) Example of DCRI site-specific report data, comparing the participant site with regional data and finally with STS national data. Hypothetical data for prolonged extubation (extubation > 24 hours). Coronary artery bypass only procedures. (B) Actual data for internal mammary artery use for first-time coronary artery bypass grafting (participant data are hypothetical). Bars show 95% confidence intervals. (CQI = continuous quality improvement.) The Annals of Thoracic Surgery 2000 69, 680-691DOI: (10.1016/S0003-4975(99)01538-6)