title: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Version 2.73: More Is Better.
abstract: BACKGROUND
  With the introduction of version 2.73, several new patient risk factors are now captured in The Society of Thoracic Surgeons' (STS) Adult Cardiac Surgery Database. We sought to evaluate the potential association of these risk factors with mortality.
  
  
  METHODS
  We reviewed all patients with an STS predicted risk of mortality in our statewide quality collaborative database from July 2011 to September 2013 (N = 19,743). Univariate analyses were used to determine significant associations between mortality and the new risk factors in version 2.73. We then performed multivariable analysis, incorporating the STS predicted risk of mortality into our regression.
  
  
  RESULTS
  In the univariate model, patients with illicit drug use, syncope, unresponsive neurologic state, cancer within the last 5 years, current smoking history, other tobacco use, or sleep apnea had no significant difference in mortality (p > 0.05). Patients with liver disease, elevated Model for End-Stage Liver Disease score, mediastinal radiation, prolonged 5-meter walk test, home oxygen use, inhaled medications or bronchodilator therapy, decreased forced expiratory volume, and history of recent pneumonia had significant increases in operative mortality (p < 0.05). In multivariable analysis incorporating the STS predicted risk models, liver disease, elevated Model for End-Stage Liver Disease score, prolonged 5-meter walk test, home oxygen use, bronchodilator therapy, and abnormal pulmonary function tests were independently predictive of mortality.
  
  
  CONCLUSIONS
  Several of the new STS data variables were significantly associated with operative mortality after cardiac surgery. The addition of these patient factors improves our understanding of evolving patient demographics and comorbid conditions and their impact on perioperative risk. This will improve both shared decision making and assessments of provider performance.
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, Michigan.
authors.forename: Terry
authors.initials: T
authors.lastname: Shih
authors.affiliation: Division of Cardiac Surgery, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paone
authors.affiliation: Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, Ann Arbor, Michigan.
authors.forename: Patricia F
authors.initials: PF
authors.lastname: Theurer
authors.affiliation: The Society of Thoracic Surgery, Chicago, Illinois.
authors.forename: Donna
authors.initials: D
authors.lastname: McDonald
authors.affiliation: Center for Quality and Safety and Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: David M
authors.initials: DM
authors.lastname: Shahian
authors.affiliation: Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan. Electronic address: rprager@umich.edu.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Prager
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D016208:Databases, Factual; D006801:Humans; D018570:Risk Assessment; D012307:Risk Factors; D012955:Societies, Medical; D013903:Thoracic Surgery