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Ann Thorac Surg 1999;68:349
© 1999 The Society of Thoracic Surgeons

Data Base Panel

Accountability: the future application of cardiothoracic surgical data in a changing health care environment

George C. Kaiser, MD, President, The Society of Thoracic Surgeonsa

a Department of Surgery, St. Louis University Health Sciences Center, St. Louis, Missouri, USA

Address reprint requests to Dr Kaiser, Dept of Surgery, St. Louis University Health Sciences Center, 3635 Vista Ave, PO Box 15250, St. Louis, MO 63110-0250

Presented at the Thirty-fourth Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 26–28, 1998.

There will be some very interesting and informative discussions this morning, which I think you will enjoy. Fred Grover is going to moderate the panel, but I wanted to make a few comments because I think data bases are a very important aspect of our future.

I have had a personal interest in multiinstitutional data bases for more than 25 years. This was stimulated chiefly by my involvement in the Coronary Artery Surgery Study (CASS). Ward Kennedy made a presentation before the American Association for Thoracic Surgery 18 years ago [1], in which he showed variability in institutional operative mortality (Fig 1). The CASS Oversight Committee—now called the Safety and Data Monitoring Committee—visited the institutions with higher operative mortalities, examined their techniques and procedures, and made suggestions to improve the mortality statistics.



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  		Fig 1. The operative mortality (open bars) and observed over-expected mortality ratio (O/E) (shaded bars) are shown for individual participating sites for coronary artery bypass grafting procedures in the Collaborative Study in Coronary Artery Surgery (CASS). Note the individual variation in the O/E ratios among the institutions, with four institutions having a greater than 1.0 O/E ratio, indicating a greater than expected operative mortality. The CASS Oversight Committee used these data to improve the operative mortality in the high outliers, and thus initiated the use of risk-adjusted operative mortality as a quality improvement measure. Redrawn from data from Kennedy JW, Kaiser GC, Fisher LD, et al. Multivariate discriminant analysis of the clinical and angiographic predictors of operative mortality from the Collaborative Study in Coronary Artery Surgery (CASS). J Thorac Cardiovasc Surg 1980;80:876–87.

 
The CASS study was a forerunner of the technique that has been used so successfully by the Northern New England Cardiovascular Disease Study Group. To my knowledge, it was the first time that the concept of observed-to-expected results was proposed publicly.

I would like to offer this quote as an introduction to today’s discussion. "The practice of medicine will always be partly an art. But now, with information technology, with more research, and with professionals who combine clinical skills, it is possible to ground medical practice more in science as well as in art" [2].

References

  1. Kennedy J.W., Kaiser G.C., Fisher L.D., et al. Multivariate discriminant analysis of the clinical and angiographic predictors of operative mortality from the Collaborative Study in Coronary Artery Surgery (CASS). J Thorac Cardiovasc Surg 1980;80:876-887.[Abstract]
  2. Inglehart J.K. Physicians as agents of social control. Health Affairs 1998;17:90-96.[Medline]




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