Continuing its commitment to increase public awareness and understanding of cardiothoracic surgical outcomes, the Society of Thoracic Surgeons (STS) has released the first publicly accessible national report of surgical outcomes from its Congenital Heart Surgery Database (CHSD). The CHSD is a component of the world-renowned STS National Database, which is widely considered the gold standard for a medical specialty clinical outcomes database.
"The public reporting of these results represents something entirely new, in that this is the first time ever that paediatric and congenital heart surgery outcomes in the US have been made available to the public on a national level," said Dr Jeffrey P Jacobs, chair of the STS Public Reporting Task Force and professor of surgery at the Johns Hopkins University. "STS has always been a strong advocate of transparency within the specialty. We believe that our patients and their families have the right to know the outcomes of cardio-thoracic surgery procedures so that they can make well-informed decisions."
The CHSD is the largest database in North America focused exclusively on paediatric and congenital cardiac malformations; more than 95% of hospitals in the US that perform paediatric heart surgery submit surgical data.
For the first round of STS Public Reporting Online from the CHSD, 25 sites (22.7%) participated, which closely resembles the level of participation in the first round of public reporting from the STS Adult Cardiac Surgery Database (ACSD) that began five years ago. ACSD participation is now at 42.7% (453 sites). For the CHSD participants who volunteered to publicly report, STS released 4-year observed, expected, and risk-adjusted centre-level operative mortality rates for the aggregate of all patients, as well as for patients stratified on the basis of the five STAT Mortality Categories (surgical procedures grouped by complexity).
Outcomes have been risk-adjusted to take into account procedural complexity and individual patient factors such as age, weight, non-cardiac abnormalities (including chromosomal abnormalities), previous surgeries, preoperative co-morbidities, and other medical conditions that could affect results.
"Reporting hospital surgical outcomes using risk-adjusted analysis is extremely important because it allows for a fair assessment, on a level playing field, of outcomes across hospitals that treat different populations of patients," said Dr Marshall L Jacobs, chair of the STS CHSD Task Force. "As paediatric and congenital cardiac surgeons, we perform operations on patients born with a wide variety of heart defects of varying complexity, and many patients have additional risk factors. Adjusting for these risk factors allows us to better understand reported mortality rates, especially for centres that operate on the most challenging patients."
Unlike ACSD public reporting, which includes a star-ratings system to report hospital outcomes, star ratings are not currently reported for the CHSD. Star ratings, based on a hospital’s overall risk-adjusted observed-to-expected operative mortality ratio, will be added to the summer 2015 release. "Public access to outcomes data for adult heart surgery and now paediatric and congenital heart surgery is at an unprecedented level and will continue to increase," said Dr Jeffrey Jacobs. "Next year, we plan to add public reporting for STS General Thoracic Surgery Database participants, starting with outcomes for lobectomy in cancer patients."
Penn State Hershey Children's Hospital is part of a first-of-its-kind report released today on paediatric and congenital heart surgery. The report on paediatric cardiac surgery outcomes is a first of its kind in Pennsylvania, and is the only state-wide reporting effort like it in the nation.
The report from the Pennsylvania Health Care Cost Containment Council (PHC4) shows Penn State Hershey's mortality figures to be no different than those of leading children’s hospitals across the US. With regard to neonates – children who required heart surgery in the first 30 days of life – Penn State Hershey's outcomes were better than the national average.
The report includes data from five hospitals – four in Pennsylvania and one in Delaware. It provides the public with volume and in-hospital mortality data on nine widely-performed heart surgeries. The data reported was provided to PHC4 by the Society of Thoracic Surgeons and covers the four-year period of 2009-12, the most recent data available.
"This report reinforces for families in central Pennsylvania that they don’t have to leave the region to find great heart care for their children," said Dr A Craig Hillemeier, dean of Penn State College of Medicine, CEO of Penn State Hershey Medical Centre and Health System, and Penn State's senior vice president for health affairs.
[link url="http://www.sts.org/news/heart-surgery-outcomes-pediatric-and-congenital-patients-now-online"]The Society of Thoracic Surgeons material[/link]
[link url="http://www.sts.org/quality-research-patient-safety/sts-public-reporting-online"]Public reporting site[/link]
[link url="http://news.psu.edu/story/346407/2015/02/26/penn-state-hershey-part-new-report-pediatric-cardiac-surgery-outcomes"]Penn State University material[/link]
[link url="http://www.phc4.org/reports/cabg/pediatric/12/docs/cardiac_pediatric2012report_embargoed.pdf"]Pediatric and Congenital surgery report[/link]