The Society of Thoracic Surgeons Mitral Valve Repair/Replacement Plus Coronary Artery Bypass Grafting Composite Score: A Report of The Society of Thoracic Surgeons Quality Measurement Task Force

摘要

Background The Society of Thoracic Surgeons (STS) Quality Measurement Task Force has developed a composite performance measure for mitral repair/replacement (MVRR) with concomitant coronary artery bypass grafting (CABG).;Methods Data were acquired from the STS Adult Cardiac Surgery Database for 26,463 patients undergoing MVRR?+ CABG operations between July 1, 2011, and June 30, 2014. Established STS risk models were applied, along with modifications enabling the inclusion of patients with concomitant closures of atrial septal defects and patent foramen ovale, surgical ablation for atrial fibrillation, and tricuspid valve repair (TVR). Participants with fewer than 10 eligible cases over 3 years were excluded. The MVRR?+ CABG composite consisted of two domains: risk-adjusted mortality and the any-or-none occurrence of major morbidity (prolonged ventilation, deep sternal infection, permanent stroke, renal failure, and reoperation). Composite performance scores were calculated with the use of hierarchic regression models, and high-performing and low-performing outliers were determined with the use of 95% Bayesian credible intervals.;Results There were 24,740 patients at 703 participant sites after exclusions. Two percent (14/703) of programs were classified as 1-star (lower than expected performance), 95% (666/703) were classified as 2-star (as-expected performance), and 3% (23/703) were classified as 3-star (higher than expected performance). The average unadjusted operative mortality was 6.2% (1,532/24,740), and a monotonic decline in both mortality and morbidity was observed as star rating scores increased.;Conclusions An STS composite performance measure was developed for MVRR?+ CABG operations. This measure may be useful for outcome assessment, quality improvement, patient counseling, clinical research, and public reporting.;;Dr Rankin discloses a financial relationship with BioStable Science and Engineering Inc., Admedus Corp, and AtriCure USA.;The Supplemental TablesSupplemental Tables can be viewed in the online version of this article [http://dx.doi.org/10.1016/j.athoracsur.2016.09.035] on http://www.annalsthoracicsurgery.org.;Jump to SectionMaterial and MethodsPatient PopulationEstimation of Risk-Adjusted Outcome MeasuresEstimation of the Composite Measure Score and Star?RatingsSensitivity Analysis: Mitral Disease EtiologySensitivity Analysis: Expanded Inclusion CriteriaResultsCommentLimitationsConclusionSupplementary DataReferences;The study population consisted of 26,463 adult patients undergoing MVRR?+ CABG in North America between July 1, 2011, and June 30, 2014. Data were collected by use of the STS Adult Cardiac Surgery Database (ACSD) version 2.73, and all patients receiving MVRR?+ CABG were initially included. Patients who had arrhythmia devices (eg, internal cardiac defibrillators), transmyocardial revascularization, concomitant vascular or pulmonary procedures, prior mitral clip, and missing age, sex, or both were subsequently excluded, as were STS participants outside the United States or those with fewer than 10 eligible cases over 3 years. The study population included patients with any acuity status (including emergency and salvage), those with closure of atrial septal defects or patent foramen ovale, operations for endocarditis (active or treated), reoperations, surgical ablation procedures (both intracardiac and extracardiac) for atrial fibrillation (AF), and concomitant tricuspid valve repair (TVR). These inclusion and exclusion criteria differ slightly from the STS 2008 risk models [1, 2, 3] and were selected to better reflect evolving science and practice trends. For example, discretionary procedures such as concomitant TVR are usually not included in risk models. However, we did so in this instance for two reasons. First, TVR may serve as an additional marker beyond severity of tricuspid regurgitation for more advanced tricuspid disease and right ventricular dysfunction. Second, TVR may confer long-te