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a Massachusetts General Hospital, Boston, Massachusetts
b Division of Cardiothoracic Surgery, University of Florida, Jacksonville, Florida
* Address correspondence to Dr Shahian, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 (Email: dshahian{at}partners.org).
Risk models have been utilized by The Society of Thoracic Surgeons (STS) for nearly 2 decades to adjust cardiac surgery outcomes for preoperative patient characteristics and disease severity. Such risk-adjusted outcomes have been widely used for research and patient counseling. In recent years, they have also been used increasingly to provide benchmark comparisons among providers and to serve as the basis for public reporting and pay-for-performance reimbursement.
This three-part supplement describes the development and validation of 27 new STS adult cardiac surgery risk models for 2008. The implementation of these models in January 2008 was coordinated with the release of the Adult Cardiac Surgery Database version 2.61, a major revision of data specifications undertaken by the STS Database Modernization Task Force.
This is the most comprehensive and cohesive set of new risk models since the inception of the STS Database, and it represents nearly a year of work by the STS Quality Measurement Task Force and the Duke Clinical Research Institute. Although knowledge of previous STS risk models was helpful in this process, these new models were developed largely de novo. Notably, they include new valve and valve plus coronary artery bypass graft surgery models that differentiate between mitral valve replacement and repair. They also include an expanded, standardized set of outcomes for all procedures (mortality, stroke, reoperation, renal failure, deep sternal wound infection, prolonged ventilation, composite major morbidity, prolonged length of stay, and short length of stay).
The transparency and granularity of this series of reports is another distinguishing feature of the 2008 STS risk models. As the use of risk models expands into areas such as provider benchmarking, regulatory compliance, and reimbursement, STS believes that the development and performance of such models should be just as transparent as the clinical performance they are designed to measure. These articles illustrate both the science and the art of risk model development. Thus, we present not only the essential statistical steps in model development but also the many subjective considerations that were discussed, many of which required expert clinical input. The rationale behind all modeling decisions is presented thoroughly and unambiguously.
It is our hope that these new risk models will not only be of value to stakeholders with an interest in adult cardiac surgery, but that they will also provide a practical illustration for others embarking on such initiatives. Finally, we believe that these models establish a new standard of transparency for any risk algorithms used to assess provider performance.
David M. Shahian, MD
Chair, STS Adult Cardiac Surgery Database Task Force
Chair, STS Quality Measurement Task Force
Fred H. Edwards, MD
Chair, STS Workforce on National Databases
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