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Ann Thorac Surg 2007;84:1416-1421
© 2007 The Society of Thoracic Surgeons

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Report From The STS Congenital Database Task Force and Joint EACTS-STS Congenital Database Committee

What is Operative Morbidity? Defining Complications in a Surgical Registry Database^_*

^a The Congenital Heart Institute of Florida, All Children’s Hospital, Children’s Hospital of Tampa, University of South Florida, St. Petersburg, Florida
^b St Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania
^c Children’s Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
^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, 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
^m Department of Anesthesiology, The Cleveland Clinic Foundation, Cleveland, Ohio
ⁿ Department of Anesthesiology, The University of Miami, Miami, Florida
^o Division of Cardiology, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts

^_* Address correspondence to Dr Mavroudis, Division of Cardiovascular-Thoracic Surgery—M/C #22, Children’s Memorial Hospital, 2300 Childrens’s Plaza, Chicago, IL 60614 (Email: cmavroudis@childrensmemorial.org).

	Executive Summary

 
During the last 2 decades, mortality after surgery for congenital heart disease has decreased dramatically and is now 4% in several large multicenter studies [1–6]. To allow for complete evaluation of quality of care in the field of congenital heart surgery, alternative methodologies must be developed that go beyond mortality or adjusted mortality to include morbidity assessment. The European Association for Cardio-Thoracic Surgery (EACTS) and The Society of Thoracic Surgeons (STS) Congenital Heart Databases, two of the most widely used tools to report and evaluate quality of care in congenital heart surgery, are the ideal platforms upon which may be developed a systematic characterization of operative morbidity.

The STS Congenital Database Task Force and the Joint EACTS-STS Congenital Database Committee previously defined operative mortality [7, 8] and herein address various terms relating to operative complications to arrive at a standardized terminology that would find broad acceptance among database users. Also addressed are the time intervals that delineate intraoperative and postoperative complications, as well as measurable indices of morbidity, such as length of postoperative intubation. Certain potentially important measures are problematic because of institutional variation in practice patterns (eg, intensive care unit stay). For this reason, the Task Force is disposed to prefer terms and intervals that are less subject to individual institutional protocols.

We define the term complication to be a universal term, encompassing both events related to the disease process and events related to healthcare interventions. In previous reports that address quality of care and patient safety, investigators have chosen to focus on a variety of related terms that fall under the broad categorization of complications [9–14]. It is important to acknowledge fundamental differences between medical errors, adverse events, and iatrogenesis. Medical errors can be the cause of adverse events; . . . [Full Text of this Article]