STS News, Winter 2021 — A year after the next generation STS National Database was launched, providing landmark advancements for the most robust clinical outcomes registry in cardiothoracic surgery, significant new features continue to roll out, helping participants with self-assessment, quality improvement, and—most important—patient care.
Risk-adjusted dashboards for the Adult Cardiac Surgery Database (ACSD) and General Thoracic Surgery Database (GTSD) are anticipated later this month. These dashboards will allow participants to compare their risk-adjusted institutional results with benchmarked STS aggregate data.
Also expected soon are the highly anticipated longitudinal dashboard reports, which have been undergoing careful development and extensive testing.
“The ACSD longitudinal dashboard will be launched first, followed by the GTSD and CHSD,” explained Felix G. Fernandez, MD, MSc, chair of the STS Workforce on National Database. “Participants will be able to view outcomes such as risk-adjusted mortality rates and observed-to-expected mortality ratios over time. The goal is to provide meaningful and actionable data to aid with continuous performance improvement, as well as help facilitate informed decision-making conversations with patients.”
The ACSD also was first to experience a data specification upgrade in the new platform. Now with that upgrade firmly in the rearview mirror, beta testing and refinements are a focus for the GTSD data specification upgrade (v5.21), which is expected to go live in July.
“This new version includes upgrades in the staging of thoracic malignancies and greater detail on thoracic operations, including more specificity on minimally invasive approaches,” said Dr. Fernandez. “Importantly, grading scales have been added for operative complications in the GTSD. This will allow for the relative severity of a complication to be ascertained from minor to life threatening. This approach may, in the future, refine definitions of major morbidities in thoracic risk models.”
Also important for the GTSD is the lung cancer composite that was added to the portfolio of performance measures to complement the lobectomy for lung cancer measure.
“Lung cancer can be removed with varying extents of pulmonary resection from wedge to pneumonectomy; extent of resection impacts operative risk and may be at the discretion of the operating surgeon. Therefore, it was important to create a lung cancer resection model that encompasses all extents of pulmonary resection for a more comprehensive measure of lung cancer surgery,” said Dr. Fernandez.
Detailed information on the new composite is expected to be published soon in The Annals of Thoracic Surgery. A separate article in The Annals will focus on analyses conducted on the impact of smoking status and surgical approach (thoracotomy vs. minimally invasive) on lung cancer resection outcomes.
Indian Society Joins ACSD
The newly formed Society of Coronary Surgeons in India and all of its member surgeons are now participants in the ACSD. Although sites in India previously participated in the CHSD, this is a first for the ACSD and provides a great opportunity for collaboration with surgeons who perform high volumes of cardiac procedures. This collaboration will extend not only to quality assessment and improvement, but also may involve research.
Data Harvests and Public Reporting
During the first year of the Database transition, COVID-19 greatly impacted hospitals. Data harvest deadlines were extended, harvest reports were delayed and public reporting was put on hold in order to carefully review the impact of the pandemic on cardiothoracic surgical patients.
The 2020 hiatus in public reporting provided an opportunity to revamp the public reporting website to allow increased search functionality, as well as new outcomes results. The release of the updated website is planned for early 2021. And as the ACSD, GTSD, and CHSD prepare to resume public reporting, the STS/ACC TVT Registry is taking steps for its first foray into public reporting (see page 13).
Future Innovations
Behind the scenes, many surgeon volunteers, STS staff, vendors, and others are working tirelessly on future innovations and game-changing practice improvement tools and programs for the STS National Database and its approximately 4,300 surgeon participants.
These projects include using artificial intelligence to assist with data entry, a site visit program for participants who want help with process improvement, and implementation of supplemental datasets for even more comprehensive outcomes analyses.
Through a collaboration with Northwestern University, National Death Index (NDI) follow-up data were acquired for more than 2.6 million unique patient records in the ACSD, GTSD, and CHSD. After data adjudication and merging, three subspecialty analytic datasets will be created for use through the STS Research Center.
In addition to death data, STS has acquired socioeconomic status data on 4.2 million records in the Database. Socioeconomic data tables mapped to specific geocodes are now available to STS for linking to project-specific datasets. The derived geocodes also will be used to calculate an Area Deprivation Index measure for use in research and quality initiatives.
“Data enhancements such as the NDI and socioeconomic status are central to our mission to deliver high-quality and long-term value to our patients and the public,” said Kevin W. Lobdell, MD, LTC, MC, USAR, chair of the STS Workforce on Research Development.
For the latest on the STS National Database, go to sts.org/database. For more information on the STS Research Center projects, visit sts.org/researchcenter.