title: The STS AVR+CABG composite score: a report of the STS Quality Measurement Task Force.
abstract: BACKGROUND
  The Society of Thoracic Surgeons (STS) is developing a portfolio of composite performance measures for the most commonly performed adult cardiac procedures. This manuscript describes the third composite measure in this series, aortic valve replacement (AVR) combined with coronary artery bypass grafting surgery (CABG).
  
  
  METHODS
  We identified all patients in the STS Adult Cardiac Surgery Database who underwent AVR+CABG during recent 3-year (July 1, 2009, through June 30, 2012) and 5-year (July 1, 2007, through June 30, 2012) periods. Variables from the STS risk model for AVR+CABG were used to adjust morbidity and mortality outcomes. Evidence for internal mammary artery use in AVR+CABG was examined. We compared composite measures constructed using 3 or 5 years of outcomes with Bayesian credible intervals of 90%, 95%, or 98%. The final STS AVR+CABG composite performance measure is based on 3 years of data and 95% credible intervals. It includes risk-adjusted mortality and morbidity but not internal mammary artery use.
  
  
  RESULTS
  Median composite score is 91.0% (interquartile range, 89.5% to 92.2%). There were 2.6% (24 of 915) one-star (lower performing) and 6.5% (59 of 915) three-star (higher performing) programs. Morbidity and mortality decrease monotonically as star ratings increase. The percentage of three-star programs increased substantially among programs that performed more than 150 procedures over 3 years compared with those performing 25 to 50 procedures (32.8% versus 1.6 %). Measure reliability was 0.51.
  
  
  CONCLUSIONS
  The STS has developed a composite performance measure for AVR+CABG based on 3-year data samples and 95% credible intervals. This composite measure identified 9.1% of STS participants as having higher or lower than expected performance.
authors.affiliation: Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: dshahian@partners.org.
authors.forename: David M
authors.initials: DM
authors.lastname: Shahian
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Xia
authors.initials: X
authors.lastname: He
authors.affiliation: All Children's Hospital, John Hopkins University, St. Petersburg, Florida.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.affiliation: Centennial Medical Center, Vanderbilt University, Nashville, Tennessee.
authors.forename: J Scott
authors.initials: JS
authors.lastname: Rankin
authors.affiliation: Children's Hospital of Illinois and the University of Illinois College of Medicine, Peoria, Illinois.
authors.forename: Karl F
authors.initials: KF
authors.lastname: Welke
authors.affiliation: University of Florida College of Medicine, Jacksonville, Florida.
authors.forename: Fred H
authors.initials: FH
authors.lastname: Edwards
authors.affiliation: Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Filardo
authors.affiliation: University of Michigan Health System Cardiac Surgery Department, Crittenton Hospital, Rochester, Michigan.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Fazzalari
authors.affiliation: Starr-Wood Cardiac Group, Portland, Oregon.
authors.forename: Anthony
authors.initials: A
authors.lastname: Furnary
authors.affiliation: Columbia HeartSource, New York, New York.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Kurlansky
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Brennan
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
authors.forename: Vinay
authors.initials: V
authors.lastname: Badhwar
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Brien
mesh_terms: D000328:Adult; D026683:Advisory Committees; D000368:Aged; D001021:Aortic Valve / Q000601:surgery*; D001499:Bayes Theorem; D002423:Cause of Death; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality*; D016208:Databases, Factual; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011475:Prosthesis Failure; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D012955:Societies, Medical; D016019:Survival Analysis; D013903:Thoracic Surgery; D014481:United States