The Society of Thoracic Surgeons Composite Measure of Individual Surgeon Performance for Adult Cardiac Surgery: A Report of The Society of Thoracic Surgeons Quality Measurement Task Force.
BACKGROUND
Previous composite performance measures of The Society of Thoracic Surgeons (STS) were estimated at the STS participant level, typically a hospital or group practice. The STS Quality Measurement Task Force has now developed a multiprocedural, multidimensional composite measure suitable for estimating the performance of individual surgeons.


METHODS
The development sample from the STS National Database included 621,489 isolated coronary artery bypass grafting procedures, isolated aortic valve replacement, aortic valve replacement plus coronary artery bypass grafting, mitral, or mitral plus coronary artery bypass grafting procedures performed by 2,286 surgeons between July 1, 2011, and June 30, 2014. Each surgeon's composite score combined their aggregate risk-adjusted mortality and major morbidity rates (each weighted inversely by their standard deviations) and reflected the proportion of case types they performed. Model parameters were estimated in a Bayesian framework. Composite star ratings were examined using 90%, 95%, or 98% Bayesian credible intervals. Measure reliability was estimated using various 3-year case thresholds.


RESULTS
The final composite measure was defined as 0.81 × (1 minus risk-standardized mortality rate) + 0.19 × (1 minus risk-standardized complication rate). Risk-adjusted mortality (median, 2.3%; interquartile range, 1.7% to 3.0%), morbidity (median, 13.7%; interquartile range, 10.8% to 17.1%), and composite scores (median, 95.4%; interquartile range, 94.4% to 96.3%) varied substantially across surgeons. Using 98% Bayesian credible intervals, there were 207 1-star (lower performance) surgeons (9.1%), 1,701 2-star (as-expected performance) surgeons (74.4%), and 378 3-star (higher performance) surgeons (16.5%). With an eligibility threshold of 100 cases over 3 years, measure reliability was 0.81.


CONCLUSIONS
The STS has developed a multiprocedural composite measure suitable for evaluating performance at the individual surgeon level.
Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts. Electronic address: dshahian@partners.org.
David M
DM
Shahian
Duke Clinical Research Institute, Durham, North Carolina.
Xia
X
He
Johns Hopkins All Children's Heart Institute, St. Petersburg, Florida.
Jeffrey P
JP
Jacobs
Columbia HeartSource, Columbia University College of Physicians and Surgeons, New York, New York.
Paul A
PA
Kurlansky
Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Vinay
V
Badhwar
Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Aurora, Colorado.
Joseph C
JC
Cleveland
Cardiac Surgery Department, University of Michigan Health System, Ann Arbor, Michigan.
Frank L
FL
Fazzalari
Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas.
Giovanni
G
Filardo
Department of Health Care Policy, Harvard Medical School and Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts.
Sharon-Lise T
SL
Normand
Starr-Wood Cardiac Group, Portland, Oregon.
Anthony P
AP
Furnary
HCA North Texas Division, Dallas, Texas.
Mitchell J
MJ
Magee
Cardiothoracic Surgery Associates, Nashville, Tennessee.
J Scott
JS
Rankin
Children's Hospital of Illinois and the University of Illinois College of Medicine, Peoria, Illinois.
Karl F
KF
Welke
The Society of Thoracic Surgeons, Chicago, Illinois.
Jane
J
Han
Duke Clinical Research Institute, Durham, North Carolina.
Sean M
SM
O'Brien
D000328:Adult; D001499:Bayes Theorem; D006348:Cardiac Surgical Procedures / Q000592:standards / Q000706:statistics & numerical data*; D002983:Clinical Competence; D001026:Coronary Artery Bypass; D006801:Humans; D020379:Risk Adjustment; D012955:Societies, Medical