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Ann Thorac Surg 2000;70:1143-1144
© 2000 The Society of Thoracic Surgeons

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Editorial

Similarity between the STS and New York State databases for valvular heart disease

^a Division of Cardiothoracic Surgery, University of Colorado Health Sciences Center, and the Surgical Service, Denver VA Medical Center, Denver, Colorado, USA
^b Division of Cardiothoracic Surgery, University of Florida, Jacksonville, Florida, USA

Address reprint requests to Dr Grover, Head, Division of Cardiothoracic Surgery (C-310), University of Colorado Health Sciences Center, 4200 East Ninth Ave, Denver, CO 80262

Doctor Hannon and his colleagues are to be congratulated for developing risk models for valvular cardiac surgery to further advance the New York State Cardiac Surgery Reporting System [1]. For a number of years they have issued reports for risk adjusted mortality for coronary artery bypass surgery and the development of the valvular risk models will now allow them to evaluate mortality for valvular cardiac surgery across New York State taking into account the risk factors that the patients bring with them to the operation. The Society of Thoracic Surgeons (STS) has also developed risk models for valvular surgery which are now available to all centers who participate in the STS National Database.

Of particular interest is the very close similarity in operative mortality for valvular cardiac surgery between the New York State Cardiac Surgery Reporting System

and the Society of Thoracic Surgeons Database. It is reassuring to those of us involved with the STS Database that there is this close similarity since the New York State system is closely audited, whereas the STS Database is a voluntary system. The striking similarities in operative mortality between the two databases with the STS actually having a slightly higher operative mortality certainly imply that the data in the STS Database is being entered honestly and accurately.

The STS Database Committee has recently examined its experience with valve replacement surgery [2, 3]. All risk factors contained in the STS "core dataset" were analyzed and statistical risk models of operative mortality associated with valve replacement surgery were extensively revised [3]. The population used to develop these risk models was drawn from all adult patients undergoing aortic or mitral valve replacement with or without concomitant coronary bypass grafting (CABG) from 1994 through 1997. The models were validated by using a "test set" population undergoing this type of surgery from 1998 through 1999.

There are several important differences between the New York State Cardiac Surgery Reporting System (CSCR) [1] and the recent STS study [3]. The STS population specifically excluded valve repair procedures, while the CSCR study included both aortic and mitral valvuloplasties. Double–valve procedures were not included in the STS study, but were considered in the CSCR models. There were 92,536 patients in the STS analysis, as compared to 14,190 patients in the CSCR population. The STS patients received surgery from a wide variety of centers across the country while the CSCR patients all received surgery in New York state.

In spite of these differences, we agree with the authors’ that there are striking similarities in the mortality rates, the distribution of the procedures, and the risk factor profile. Table 1 confirms that the mortality varies significantly with the type of operation performed, and also shows that there is little difference in the operative results of the STS national experience compared to the CSCR state experience. The Department of Veterans Affairs Cardiac Surgery Database was also reviewed for the same time period and revealed very similar operative mortalities (personal communication between R. Johnson, and F. L. Grover).

The development of statistical risk models was an important aspect of each study. Both groups used logistic regression techniques to develop models of operative mortality based on preoperative risk factors. Hannan’s group established separate models for each procedure, whereas the STS developed one model for isolated valve replacement and another model for valve replacement combined with CABG. Both groups tested the validity of their models using a population different from the one used to develop the models. The models demonstrated similar performance, with the CSCR models having c-index values between 0.73–0.82 and the STS models ranging from 0.74–0.77.

In conclusion, there are striking similarities both in unadjusted operative mortality and the statistically significant preoperative risk factors predictive of operative mortality following valve surgery between the New York State Cardiac Surgery Reporting System and the STS National Database and the operative mortalities of the VA Database. This close similarity further validates the accuracy and the representativeness of the STS Database as a national database and also the fact that it is very unlikely that there are major state-to-state or regional differences. The Society of Thoracic Surgeons Database Committee looks forward to the continued sharing of methodology with the New York CSRS for evaluating cardiac surgical results as a tool for the continuing effort to improve the care that we deliver to our patients. Such comparisons can serve to validate the accuracy and reliability of both databases.

References

1. Hannan E.L., Racz M.J., Jones R.H., Gold J.P., Ryan T.J., Hafner J.P., Isom O.W. Predictors of mortality for patients undergoing cardiac valve replacements in New York State. Ann Thorac Surg 2000;70:1212-1218.[Abstract/Free Full Text]
2. Jamieson W.R.E., Edwards F.H., Bero J., Clark R.E., Grover F.L. Cardiac valve replacement surgery. Ann Thorac Surg 1999;67:43-51.
3. Edwards F.H., DeLong E.R., Shroyer A.L., Anstrom K.J., Grover F.L., Peterson E.D., Jamieson W.R.E. Prediction of operative mortality following valve replacement surgery. J Am Coll Cardiol 2000;35(Suppl A):529.

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Frederick L. Grover Fred H. Edwards Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Grover, F. L. Articles by Edwards, F. H. Search for Related Content PubMed PubMed Citation Articles by Grover, F. L. Articles by Edwards, F. H.