BACKGROUND: Risk-standardized mortality rates provide a valuable but incomplete assessment of provider performance. Consequently, The Society of Thoracic Surgeons (STS) previously developed a multidimensional composite quality measure for coronary artery bypass grafting, the most frequently performed cardiac surgical procedure. The current study creates a similar composite measure for isolated aortic valve replacement (AVR). METHODS: Because there are few widely accepted process measures for AVR, the STS AVR composite score is based solely on outcomes, including risk-standardized mortality and any-or-none risk-standardized morbidity (occurrence of sternal infection, reoperation, stroke, renal failure, or prolonged ventilation). Isolated AVR is performed less frequently than coronary artery bypass grafting, and 1 year of data provided inadequate sample sizes for profiling. Therefore, we investigated observation periods of 3 years (July 1, 2007, to June 30, 2010: 67,138 records, 2,082 deaths, and 11,962 morbidity events) and 5 years (July 1, 2005, to June 30, 2010: 101,269 records, 3,123 deaths, and 17,514 morbidity events). We also compared results using 90%, 95%, and 98% credible intervals, corresponding to 95%, 97.5%, and 99% Bayesian probabilities, to determine "star ratings." RESULTS: Differences between 3-year and 5-year results were small; the former was chosen because this time frame provides more current and relevant data. Using 3 years of data and 95% credible intervals, adjusted mortality and morbidity rates varied threefold from highest performing (3 stars) to lowest performing (1 star) programs. Approximately 3% of participants were 1-star, 6% were 3-star, and 91% were 2-star programs. CONCLUSIONS: STS has developed a composite mortality and morbidity outcomes measure for isolated AVR to be used in quality assessment, provider feedback, public reporting, and performance improvement.
BACKGROUND: Risk-standardized mortality rates provide a valuable but incomplete assessment of provider performance. Consequently, The Society of Thoracic Surgeons (STS) previously developed a multidimensional composite quality measure for coronary artery bypass grafting, the most frequently performed cardiac surgical procedure. The current study creates a similar composite measure for isolated aortic valve replacement (AVR). METHODS: Because there are few widely accepted process measures for AVR, the STS AVR composite score is based solely on outcomes, including risk-standardized mortality and any-or-none risk-standardized morbidity (occurrence of sternal infection, reoperation, stroke, renal failure, or prolonged ventilation). Isolated AVR is performed less frequently than coronary artery bypass grafting, and 1 year of data provided inadequate sample sizes for profiling. Therefore, we investigated observation periods of 3 years (July 1, 2007, to June 30, 2010: 67,138 records, 2,082 deaths, and 11,962 morbidity events) and 5 years (July 1, 2005, to June 30, 2010: 101,269 records, 3,123 deaths, and 17,514 morbidity events). We also compared results using 90%, 95%, and 98% credible intervals, corresponding to 95%, 97.5%, and 99% Bayesian probabilities, to determine "star ratings." RESULTS: Differences between 3-year and 5-year results were small; the former was chosen because this time frame provides more current and relevant data. Using 3 years of data and 95% credible intervals, adjusted mortality and morbidity rates varied threefold from highest performing (3 stars) to lowest performing (1 star) programs. Approximately 3% of participants were 1-star, 6% were 3-star, and 91% were 2-star programs. CONCLUSIONS: STS has developed a composite mortality and morbidity outcomes measure for isolated AVR to be used in quality assessment, provider feedback, public reporting, and performance improvement.
Authors: Fenton H McCarthy; Lingjiao Zhang; Vicky Tam; Jinbo Chen; Chase Brown; William L Patrick; Walter Clark Hargrove; Wilson Y Szeto; Nimesh D Desai; Douglas J Wiebe; Peter W Groeneveld; Matthew L Williams Journal: Am J Cardiol Date: 2018-09-26 Impact factor: 2.778
Authors: Rohan Khera; Ambarish Pandey; Thomas Koshy; Colby Ayers; Brahmajee K Nallamothu; Sandeep R Das; Mark H Drazner; Michael E Jessen; Ajay J Kirtane; Timothy J Gardner; James A de Lemos; Deepak L Bhatt; Dharam J Kumbhani Journal: JAMA Cardiol Date: 2017-12-01 Impact factor: 14.676
Authors: Maroun Yammine; Fernando Ramirez-Del Val; Julius I Ejiofor; Robert C Neely; Diana Shi; Siobhan McGurk; Sary F Aranki; Tsuyoshi Kaneko; Prem S Shekar Journal: Ann Cardiothorac Surg Date: 2017-09
Authors: Giuseppe Tarantini; Paola A M Purita; Augusto D'Onofrio; Chiara Fraccaro; Anna Chiara Frigo; Gianpiero D'Amico; Luca Nai Fovino; Marta Martin; Francesco Cardaioli; Mostafa R A Badawy; Massimo Napodano; Gino Gerosa; Sabino Iliceto Journal: Ann Cardiothorac Surg Date: 2017-09
Authors: Jeffrey P Jacobs; Michael D Horowitz; Constantine Mavroudis; Allison Siegel; Robert M Sade Journal: Ann Thorac Surg Date: 2013-07 Impact factor: 4.330
Authors: Sara K Pasquali; David M Shahian; Sean M O'Brien; Marshall L Jacobs; J William Gaynor; Jennifer C Romano; Michael G Gaies; Kevin D Hill; John E Mayer; Jeffrey P Jacobs Journal: Ann Thorac Surg Date: 2018-09-15 Impact factor: 4.330