The Society of Cardiovascular Anesthesiologists (SCA) is pleasedto announce a groundbreaking collaboration with the Society of Thoracic Surgeons (STS) whereby adult cardiac anesthesia clinical data will soon be incorporated into the Adult Cardiac Surgery component of the STS National Database though a newly created Web-based anesthesia module.
The SCA and the STS agreed on January 28, 2013 to incorporate an adult cardiac anesthesia database module into the existing STS adult cardiac surgery database.1 This action represents a watershed moment for the SCA that helps leapfrog our specialty of cardiac anesthesia forward to shape and manage patient care with evidence-based arguments. Hence, the SCA is pleased to now be a part of this premiere data set through the creation of an Adult Cardiovascular Anesthesia module.
The STS Adult Cardiac Surgery Database is the largest cardiothoracic surgery outcomes and quality improvement registry in the world, containing more than 5 million cardiothoracic surgical procedure records from nearly 95 percent of all adult cardiac surgery centers in the United States.
The STS National Database was established over two decades ago and is perceived by many to be the benchmark database tool for quality improvement and patient safety in cardiac surgery with many measures endorsed by the National Quality Forum.
Rationale for Creating STS Database
In 1986, the Health Care Financing Administration (HCFA) established standards for medical providers and non-risk-adjusted public release of CABG mortality. Realizing the importance of clinical data for high-profile and high-cost procedures, the STS created a committee to develop a physician-operated clinical database to provide government agencies and payers with accurate risk-adjusted performance and clinical outcome data.2,3 Data collection began in 1989 for what evolved into the STS National Database. Presently, the STS database remains a physician-driven and physician-operated database with 1,071 participating cardiothoracic surgical groups that constitute more than 95 percent of practicing cardiothoracic surgeons. The STS database is the largest clinical database in cardiothoracic surgery, and its credibility is recognized and endorsed by the National Quality Forum (NQF), Ambulatory Care Quality Alliance (AQA), CMS, Food and Drug Administration (FDA), payers, purchasers and major hospital systems. The Consumers Union, the policy and action division of Consumer Reports, provides public access of individual hospital performance on a voluntary basis with star ratings based on STS outcome data.4-6
Relevance of Database to Cardiac Anesthesiology
The SCA made the decision to partner with the STS National database after careful study of all available options including the creation of an independent database. The SCA strongly believes the ability to link anesthesia and intraoperative data with surgical outcome and performance provides a powerful tool to measure the value of anesthetic practices and refine the quality of perioperative care. This partnership with the STS Adult Cardiac Surgery Database connects our soon-to-be-created databank to more than 5 million cardio-thoracic surgical procedure records.
This database will provide a benchmark for quality improvement and patient safety. Meaningful internal assessment will be possible by collecting and sharing outcomes data which should help shape evolving perceptions of patient risk and best practice decisions and policy. Clinical practice guidelines, consensus statements and work value are more intelligently derived when data exist, and this database should provide an opportunity to intelligently derive and test associative hypothesis and stimulate valuable clinical research.
Combining anesthesia and perioperative data fields to this existing adult cardiac surgery STS database will provide a means to establish how anesthesia techniques and perioperative findings relate to risk-adjusted surgical outcomes. Establishing the impact of anesthetic practices to surgical outcomes is vital to ongoing quality improvement efforts and justifying the value of specific interventions such as intraoperative transesophageal echocardiography. Active participation in the SCA/STS National database project provides objective criteria of the quality of anesthesia and perioperative care that is being delivered to cardiothoracic surgical patients in comparison to national standards and a commitment to improving patient outcomes through teamwork and data-driven quality improvement.
Participation in the SCA/STS National database project will demonstrate to the public, government agencies and health insurance industry that cardiothoracic anesthesiologists are committed to objectively quantifying how the practice of cardiothoracic anesthesiology and perioperative medicine impacts surgical outcomes.
The SCA takes pride in being committed to continuous improvement in patient safety and quality of cardiothoracic and vascular anesthesia care and believes the plan to build on the existing STS database has great upside potential for our specialty.
The Society of Cardiovascular Anesthesiologists invites and encourages you to join in participating in the SCA/STS national database for the collection of adult cardiac anesthesia clinical data, because we are in the best position to measure our clinical performance accurately and objectively. We strongly encourage everyone who is eligible to participate in this important initiative in order to promote best practices and quality care for cardiac patients cared for by cardiovascular anesthesiologists.
For more information, please visit www.scahq.org/ClinicalPracticeGuidelines/accd.html.
Solomon Aronson M.D., M.B.A., FACC, FCCP, FAHA, FASE is Director, Strategic Integration, Duke University Health System, Professor, Duke University School of Medicine, Executive Vice Chairman, Department of Anesthesiology, Durham, North Carolina.
Joseph P. Mathew, M.D., M.H.Sc., M.B.A. is Jerry Reves Professor of Cardiac Anesthesiology, Executive Vice Chair, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
1. How to become a participant: steps to participation in the STS National Database. The Society of Thoracic Surgeons website. http://www.sts.org/participate. Accessed September 17, 2013.
2. Institute of Medicine Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press, 2001. http://books.nap.edu/books/0309072808/html/index.html. Accessed September 17, 2013.
3. Peterson ED, DeLong ER, Muhlbaier LH, et al. Challenges in comparing risk-adjusted bypass surgery mortality results: results from the Cooperative Cardiovascular Project. J Am Coll Cardiol. 2000;36(7):2174-2184.
4. Centers for Medicare & Medicaid Services. CMS information security overview. CMS.gov. http://www.cms.hhs.gov/InformationSecurity/. Accessed September 17, 2013.
5. Luck J, Peabody JW, Dresselhaus TR, Lee M, Glassman P. How well does chart abstraction measure quality? Am J Med. 2000;108(8):642-649.
6. Ferguson TB Jr, Dziuban SW Jr, Edwards FH, et al. The STS National Database: current changes and challenges for the new millennium. Ann Thorac Surg. 2000;69(3):680-691. http://www.annalsthoracicsurgery.org/article/S0003-4975%2899%2901538-6/abstract. Accessed September 17, 2013.