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Ann Thorac Surg 2006;81:1937-1941
© 2006 The Society of Thoracic Surgeons

STS Congenital Database Taskforce & Joint EACTS-STS Congenital Database Committee Report

What is Operative Mortality? Defining Death in a Surgical Registry Database: A Report of the STS Congenital Database Taskforce and the Joint EACTS-STS Congenital Database Committee

Jeffrey Phillip Jacobs, MD a , * , Constantine Mavroudis, MD b , Marshall Lewis Jacobs, MD c , Bohdan Maruszewski, MD, PhD d , Christo I. Tchervenkov, MD e , François G. Lacour-Gayet, MD f , David Robinson Clarke, MD f , Thomas Yeh, Jr, MD g , Henry L. Walters, III, MD h , Hiromi Kurosawa, MD i , Giovanni Stellin, MD j , Tjark Ebels, MD, PhD k , Martin J. Elliott, FRCS l

a The Congenital Heart Institute of Florida, All Children's Hospital, Children's Hospital of Tampa, University of South Florida, St. Petersburg, Florida
b Childrens Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
c St. Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
d Children's Memorial Health Institute, Warsaw, Poland
e Montreal Children's Hospital, McGill University, Montreal, Canada
f Denver Children's Hospital, University of Colorado School of Medicine, Denver, Colorado
g Children's Medical Center, Dallas, University of Texas Southwestern Medical School, Dallas, Texas
h Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
i Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan
j University of Padova Medical School, Padova, Italy
k Groningen University Medical Centre, Groningen, the Netherlands
l Cardiac Unit, Great Ormond Street Hospital for Children, London, United Kingdom

* Address correspondence to Dr Jeffrey Phillip Jacobs, Cardiac Surgical Associates, 603 Seventh St South, Suite 450, St Petersburg, FL 33701 (Email: jeffjacobs{at}msn.com).

The most concrete and universal outcome measure used in databases, whether governmental, professional society, research, or third-party payer, is operative mortality. To assure congruous data entry by multiple users of The Society of Thoracic Surgeons and the European Association for Cardiothoracic Surgery congenital heart surgery databases, operative mortality must be clearly defined. Traditionally, operative mortality has been defined as any death, regardless of cause, occurring (1) within 30 days after surgery in or out of the hospital, and (2) after 30 days during the same hospitalization subsequent to the operation. Differing hospital practices result in problems in use of the latter part of the definition (eg, the pediatric hospital that provides longer-term care will have higher mortality rates than one which transfers patients to another institution for such care). In addition, because of the significant number of pediatric multiple operation hospitalizations, issues of assignment of mortality to a specific operation within the hospitalization, calculation of operative mortality rates (operation based vs patient admission based), and discharge other than to home must be addressed and defined. We propose refinements to the definition of operative mortality which specifically meet the needs of our professional societies' multi-institutional registry databases, and at the same time are relevant and appropriate with respect to the goals and purposes of administrative databases, government agencies, and the general public.


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Ann. Thorac. Surg. 2006 81: 1557-1560. [Extract] [Full Text] [PDF]



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