title: The Society of Thoracic Surgeons Adult Cardiac Surgery Database: The Driving Force for Improvement in Cardiac Surgery.
abstract: Initiated in 1989, the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) includes more than 1085 participating centers, representing 90%-95% of current US-based adult cardiac surgery hospitals. Since its inception, the primary goal of the STS ACSD has been to use clinical data to track and improve cardiac surgical outcomes. Patients' preoperative risk characteristics, procedure-related processes of care, and clinical outcomes data have been captured and analyzed, with timely risk-adjusted feedback reports to participating providers. In 2006, STS initiated an external audit process to evaluate STS ACSD completeness and accuracy. Given the extremely high inter-rater reliability and completeness rates of STS ACSD, it is widely regarded as the "gold standard" for benchmarking cardiac surgery risk-adjusted outcomes. Over time, STS ACSD has expanded its quality horizons beyond the traditional focus on isolated, risk-adjusted short-term outcomes such as perioperative morbidity and mortality. New quality indicators have evolved including composite measures of key processes of care and outcomes (risk-adjusted morbidity and risk-adjusted mortality), longer-term outcomes, and readmissions. Resource use and patient-reported outcomes would be added in the future. These additional metrics provide a more comprehensive perspective on quality as well as additional end points. Widespread acceptance and use of STS ACSD has led to a cultural transformation within cardiac surgery by providing nationally benchmarked data for internal quality assessment, aiding data-driven quality improvement activities, serving as the basis for a voluntary public reporting program, advancing cardiac surgery care through STS ACSD-based research, and facilitating data-driven informed consent dialogues and alternative treatment-related discussions.
authors.affiliation: Research and Development Service, Northport Veterans Affairs Medical Center, Northport, New York; Department of Surgery, Stony Brook University School of Medicine, Stony Brook, New York. Electronic address: AnnieLaurie.Shroyer@stonybrookmedicine.edu.
authors.forename: Annie Laurie
authors.initials: AL
authors.lastname: Winkley Shroyer
authors.affiliation: Department of Surgery, Baylor College of Medicine and Michael E. DeBakey VAMC, Houston, Texas.
authors.forename: Faisal
authors.initials: F
authors.lastname: Bakaeen
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: David M
authors.initials: DM
authors.lastname: Shahian
authors.affiliation: Research and Development Service, Northport Veterans Affairs Medical Center, Northport, New York; Department of Surgery, Stony Brook University School of Medicine, Stony Brook, New York.
authors.forename: Brendan M
authors.initials: BM
authors.lastname: Carr
authors.affiliation: Department of Cardiac Surgery, University of Michigan Health Care System, Ann Arbor, Michigan.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Prager
authors.affiliation: Division of Cardiovascular Surgery, Johns Hopkins All Children׳s Heart Institute, Johns Hopkins University, Saint Petersburg and Tampa, Florida.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.affiliation: Department of Surgery, University of Kentucky School of Medicine, Lexington, Kentucky.
authors.forename: Victor
authors.initials: V
authors.lastname: Ferraris
authors.affiliation: Department of Surgery, University of Florida School of Medicine, Jacksonville, Florida.
authors.forename: Fred
authors.initials: F
authors.lastname: Edwards
authors.affiliation: Department of Surgery, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado; Department of Surgery, Denver Veterans Affairs Medical Center, Denver, Colorado.
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Grover
mesh_terms: D019985:Benchmarking; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000592:standards; D002983:Clinical Competence; D016208:Databases, Factual / Q000592:standards; D006801:Humans; D017064:Process Assessment, Health Care / Q000592:standards; D058996:Quality Improvement / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards; D018570:Risk Assessment; D012307:Risk Factors; D012955:Societies, Medical; D013903:Thoracic Surgery / Q000592:standards; D013997:Time Factors; D016896:Treatment Outcome
keywords: coronary artery bypass; database; medical audit; risk assessment; treatment outcomes