Frederick L Grover, MD The Annals of Thoracic Surgery

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Presentation transcript:

The Society of Thoracic Surgeons National Database: current status and future directions Frederick L Grover, MD The Annals of Thoracic Surgery Volume 68, Issue 2, Pages 367-373 (August 1999) DOI: 10.1016/S0003-4975(99)00599-8

Fig 1 The relative number of coronary bypass procedures, valve procedures and other procedures performed which have been collected in the Summit-STS database since 1970. The patients from 1991 to the present are official STS patients; the others were already entered into the database prior to the development of the official STS database. The vast majority of the procedures entered are coronary bypass grafting operations. The Annals of Thoracic Surgery 1999 68, 367-373DOI: (10.1016/S0003-4975(99)00599-8)

Fig 2 The annual observed to expected operative mortality is listed by year for coronary artery bypass grafting procedures. Note a progressive decline in the observed and expected operative mortality over that 7-year period. The Annals of Thoracic Surgery 1999 68, 367-373DOI: (10.1016/S0003-4975(99)00599-8)

Fig 3 Both expected and observed operative mortality increase relative to the urgency or emergency of the procedure and to reoperation, with a very high risk of death in the salvage population, both first time and reoperation. The Annals of Thoracic Surgery 1999 68, 367-373DOI: (10.1016/S0003-4975(99)00599-8)

Fig 4 Estimated operative mortality is listed on the horizontal axis and the percent of patients with at least one major complication on the vertical axis. Note that there is a progressive increase in the likelihood of a major complication in the higher risk patients. The Annals of Thoracic Surgery 1999 68, 367-373DOI: (10.1016/S0003-4975(99)00599-8)

Fig 5 Total length of stay has progressively decreased over the past 7 years, decreasing from 10 days to 7 days for coronary artery bypass grafting procedures. The star with the line indicates the median and the dot the mean value. The Annals of Thoracic Surgery 1999 68, 367-373DOI: (10.1016/S0003-4975(99)00599-8)

Fig 6 There is a relationship between a greater postoperative length of stay and the higher risk patient population with the lowest risk groups having an average postoperative length of stay of 5 days and the higher risk groups 8–9 days. The Annals of Thoracic Surgery 1999 68, 367-373DOI: (10.1016/S0003-4975(99)00599-8)

Fig 7 Since the inception of the Society of Thoracic Surgeons National Database, there has been a progressive increase in the utilization of at least one internal mammary artery in coronary artery bypass grafting operations. The 1996 level was approximately 77% as compared to 47% in 1990. The Annals of Thoracic Surgery 1999 68, 367-373DOI: (10.1016/S0003-4975(99)00599-8)

Fig 8 This figure denotes the percentage of patients who underwent either a CABG or a PTCA as their first procedure who have required a secondary procedure during the 10 year-follow up in the Duke University Database. Note that there is a far greater incidence of angioplasty patients requiring a secondary procedure than the coronary artery bypass grafting group. (Reprinted with permission from Jones et al. [12].) The Annals of Thoracic Surgery 1999 68, 367-373DOI: (10.1016/S0003-4975(99)00599-8)

Fig 9 Healthcare spending as a percentage of the United States Gross National Product consistently increased from 1981–1984 from 9.6% to 15%, reaching the $1.06 trillion mark. Physician Services, however, accounted for only a relatively small 18% of this (Reprinted from the New York Times, December 29, 1993:A12. Copyright © 1993 by The New York Times. Reprinted by permission. The Annals of Thoracic Surgery 1999 68, 367-373DOI: (10.1016/S0003-4975(99)00599-8)