The Society of Thoracic Surgeons National Database: Current status and future directions

The Society of Thoracic Surgeons National Database, established seven years ago by thoracic surgeons for self improvement and quality assurance, now h as 1,181,464 patients registered, including 897,914 coronary artery bypass operations. Risk-adjusted 30 day mortality for coronary bypass procedures, unadjusted mortality for other cardiothoracic procedures, unadjusted morbid ity and length of stay as well as several processes of care are measured. There has been a progressive decrease in operative mortality and length of stay over the past seven years. Deaths, complications, and lengths of stay are stratified according to estimated risk of death. Definitions have been refined in conjunction with the American College of C ardiology. The database is being increasingly utilized for state analyses a nd is in demand by other organizations and third party carriers. Logistic r egression analysis is now utilized for development of the risk models. The database has been useful for health care policy decisions and can be useful for our Professional Affairs Committee in their dealings with govern-ment. Other uses include measuring access to care and cost. Data quality improvement measures have been put in place, as well as data m anager education. The General Thoracic and Congenital data acquisition pack ages are being modified and improved, and a goal is to begin collecting lon gitudinal data to demonstrate the long term efficacy of thoracic procedures . The data elements have been decreased from 500 to 200+ core variables for simplification. With the changing healthcare environment and emphasis on cost cutting, coll ecting valid data by a national specialty group enhances the monitoring of quality of care, thus protecting our patients from overzealous cutbacks. Da ta is essential to document the efficacy quality and cost-effectiveness of the procedures we perform and is a necessary tool for each of us to have to assure the quality and continued success of our practices. (C) 1999 by The Society of Thoracic Surgeons.