The STS Participant-Level, Multi-Procedural Composite Measure for Adult Cardiac Surgery.

2021 
ABSTRACT Background Composite performance measures for STS Adult Cardiac Surgery Database participants (typically hospital departments or practice groups) are currently available only for individual procedures. To assess overall participant performance, STS has developed a composite metric encompassing the most common adult cardiac procedures. Methods Analyses included 1-year (July 1, 2018–June 30, 2019) and 3-year (July 1, 2016–June 30, 2019) time windows. Operations included isolated CABG, isolated AVR, isolated mitral valve repair (MVr) or replacement (MVR), AVR+CABG, MVr/MVR+CABG, AVR+MVr/MVR, and AVR+MVr/MVR+CABG. The composite was estimated using Bayesian hierarchical models with risk-adjusted mortality and morbidity endpoints. Star ratings were based on whether the 95% credible interval of a participant’s score was entirely below (1-star), overlapped (2-star), or was above (3-star) the STS average composite score. Results The North American procedural mix in the 3-year study cohort was 448,569 CABG, 72,067 AVR, 35,708 MVr, 29,953 MVR, 45,254 AVR+CABG, 12,247 MVr+CABG, 10,118 MVR+CABG, 3,743 AVR+MVr, 6,846 AVR+MVR, and 3,765 AVR+(MVr/MVR)+CABG. Mortality and morbidity weightings were similar for 1- and 3-year analyses (76% and 24%, [3-year]), as were composite score distributions (median 94.7%, IQR 93.6% to 95.6%, [3-year]). The 3-year timeframe was selected for operational use because of higher model reliability (0.81 [0.78 – 0.83]) and better outlier discrimination (26% 3-star, 16% 1-star). Risk-adjusted outcomes for 1-, 2-, and 3-star programs were 4.3%, 3.0%, and 1.8% mortality, and 18.4%, 13.4%, and 9.7% morbidity, respectively. Conclusions The STS participant-level, multi-procedural composite measure provides comprehensive, highly reliable, overall quality assessment of adult cardiac surgery practices.
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