The STS Cardiac Surgery National Database: an update.

Since inception in 1990, The Society of Thoracic Surgeons (STS) National Cardiac Database has grown rapidly. More than 1,500 surgeons working in 706 hospitals have contributed more than one half million patient records. Geographic distribution of those participating is proportional to the number of centers performing heart surgery. The STS system is in use in all 49 states where centers are operating. There has been a significant decrease in length of stay for most patients having heart operations and a modest fall in coronary artery bypass grafting operative mortality from 3.7% to 3.3% over the past 3 years. Coronary artery bypass grafting case mix also is changing nationally as evidenced by a decline of 17% in the best-risk cases and concomitant increases in those with predicted risks of 5% to 10% and greater. New uses for local data in addition to self assessment and quality assurance include development of critical clinical pathways, support for managed-care group applications, and regional use. Minnesota has established a statewide STS system and Florida is soon to follow. The key to acceptance has been a peer-reviewed risk-stratification system that continues to be refined each year. Finally, a major effort will be made this year to increase the participation of general thoracic surgeons, particularly with respect to lung cancer.