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The Society of Thoracic Surgeons Coronary Artery Bypass Graft Composite Measure: 2021 Methodology Update.

Publication ,  Journal Article
Shahian, DM; Bowdish, ME; Bloom, JP; Wyler von Ballmoos, MC; Edgerton, JR; Antman, MS; Kurlansky, PA; Lobdell, KW; Cleveland, JC; Gaudino, MFL ...
Published in: Ann Thorac Surg
June 2022

BACKGROUND: The Society of Thoracic Surgeons (STS) original coronary artery bypass graft surgery (CABG) composite measure uses a 1-year analytic cohort and 98% credible intervals (CrI) to classify better than expected (3-star) performance or worse than expected (1-star) performance. As CABG volumes per STS participant (eg, hospital or practice group) have decreased, it has become more challenging to classify performance categories using this approach, especially for lower volume programs, and alternative approaches have been explored. METHODS: Among 990 STS Adult Cardiac Surgery Database participants, performance classifications for the CABG composite were studied using various analytic cohorts: 1 year (current approach, 2017); 3 years (2015 to 2017); last 450 cases within 3 years; and most recent year (2017) plus additional cases to 450 total. We also compared 98% CrI with 95% CrI (used in other STS composite measures). RESULTS: Using 3 years of data and 95% CrIs, 113 of 990 participants (11.4%) were classified 1-star and 198 (20%) 3-star. Compared with 1-year analytic cohorts and 98% CrI, the absolute and relative increases in the proportion of 3-star participants were 14 percentage points and 233% (n = 198 [20%] vs n = 59 [6%]). Corresponding changes for 1-star participants were 6.5 percentage points and 133% (n = 113 [11.4%] vs n = 48 [4.9%]). These changes were particularly notable among lower volume (fewer than 199 CABG per year) participants. Measure reliability with the 3-year, 95% CrI modification is 0.78. CONCLUSIONS: Compared with current STS CABG composite methodology, a 3-year analytic cohort and 95% CrI increases the number and proportion of better or worse than expected outliers, especially among lower-volume Adult Cardiac Surgery Database participants. This revised methodology is also now consistent with other STS procedure composites.

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Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

June 2022

Volume

113

Issue

6

Start / End Page

1954 / 1961

Location

Netherlands

Related Subject Headings

  • Thoracic Surgery
  • Surgeons
  • Societies, Medical
  • Respiratory System
  • Reproducibility of Results
  • Postoperative Complications
  • Humans
  • Coronary Artery Bypass
  • Adult
  • 3202 Clinical sciences
 

Citation

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Shahian, D. M., Bowdish, M. E., Bloom, J. P., Wyler von Ballmoos, M. C., Edgerton, J. R., Antman, M. S., … STS Workforce on Quality and its Quality Measurement Task Force, . (2022). The Society of Thoracic Surgeons Coronary Artery Bypass Graft Composite Measure: 2021 Methodology Update. Ann Thorac Surg, 113(6), 1954–1961. https://doi.org/10.1016/j.athoracsur.2021.06.036
Shahian, David M., Michael E. Bowdish, Jordan P. Bloom, Moritz C. Wyler von Ballmoos, James R. Edgerton, Mark S. Antman, Paul A. Kurlansky, et al. “The Society of Thoracic Surgeons Coronary Artery Bypass Graft Composite Measure: 2021 Methodology Update.Ann Thorac Surg 113, no. 6 (June 2022): 1954–61. https://doi.org/10.1016/j.athoracsur.2021.06.036.
Shahian DM, Bowdish ME, Bloom JP, Wyler von Ballmoos MC, Edgerton JR, Antman MS, et al. The Society of Thoracic Surgeons Coronary Artery Bypass Graft Composite Measure: 2021 Methodology Update. Ann Thorac Surg. 2022 Jun;113(6):1954–61.
Shahian, David M., et al. “The Society of Thoracic Surgeons Coronary Artery Bypass Graft Composite Measure: 2021 Methodology Update.Ann Thorac Surg, vol. 113, no. 6, June 2022, pp. 1954–61. Pubmed, doi:10.1016/j.athoracsur.2021.06.036.
Shahian DM, Bowdish ME, Bloom JP, Wyler von Ballmoos MC, Edgerton JR, Antman MS, Kurlansky PA, Lobdell KW, Cleveland JC, Gaudino MFL, Paone G, Vassileva C, Thourani VH, Furnary AP, Badhwar V, Jacobs JP, O’Brien SM, STS Workforce on Quality and its Quality Measurement Task Force. The Society of Thoracic Surgeons Coronary Artery Bypass Graft Composite Measure: 2021 Methodology Update. Ann Thorac Surg. 2022 Jun;113(6):1954–1961.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

June 2022

Volume

113

Issue

6

Start / End Page

1954 / 1961

Location

Netherlands

Related Subject Headings

  • Thoracic Surgery
  • Surgeons
  • Societies, Medical
  • Respiratory System
  • Reproducibility of Results
  • Postoperative Complications
  • Humans
  • Coronary Artery Bypass
  • Adult
  • 3202 Clinical sciences