What is operative mortality? Defining death in a surgical registry database: a report of the STS Congenital Database Taskforce and the Joint EACTS-STS Congenital Database Committee.
The most concrete and universal outcome measure used in databases, whether governmental, professional society, research, or third-party payer, is operative mortality. To assure congruous data entry by multiple users of The Society of Thoracic Surgeons and the European Association for Cardiothoracic Surgery congenital heart surgery databases, operative mortality must be clearly defined. Traditionally, operative mortality has been defined as any death, regardless of cause, occurring (1) within 30 days after surgery in or out of the hospital, and (2) after 30 days during the same hospitalization subsequent to the operation. Differing hospital practices result in problems in use of the latter part of the definition (eg, the pediatric hospital that provides longer-term care will have higher mortality rates than one which transfers patients to another institution for such care). In addition, because of the significant number of pediatric multiple operation hospitalizations, issues of assignment of mortality to a specific operation within the hospitalization, calculation of operative mortality rates (operation based vs patient admission based), and discharge other than to home must be addressed and defined. We propose refinements to the definition of operative mortality which specifically meet the needs of our professional societies' multi-institutional registry databases, and at the same time are relevant and appropriate with respect to the goals and purposes of administrative databases, government agencies, and the general public.
Jacobs
Jeffrey Phillip
JP
The Congenital Heart Institute of Florida, All Children's Hospital, University of South Florida, St. Petersburg, Florida, USA. jeffjacobs@msn.com
Mavroudis
Constantine
C
Jacobs
Marshall Lewis
ML
Maruszewski
Bohdan
B
Tchervenkov
Christo I
CI
Lacour-Gayet
François G
FG
Clarke
David Robinson
DR
Yeh
Thomas
T
Walters
Henry L
HL
Kurosawa
Hiromi
H
Stellin
Giovanni
G
Ebels
Tjark
T
Elliott
Martin J
MJ
D006348:Cardiac Surgical Procedures / Q000401:mortality*; D005060:Europe; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000145:classification*; D010351:Patient Discharge; D012042:Registries; D018570:Risk Assessment; D014481:United States