Ring W Steves, Edgerton James R, Herbert Morley, Prince Syma, Knoff Cathy, Jenkins Kristin M, Jessen Michael E, Hamman Baron L
Department of Cardiovascular & Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Texas Quality Initiative, Dallas-Fort Worth Hospital Council Foundation, Irving, Texas.
Texas Quality Initiative, Dallas-Fort Worth Hospital Council Foundation, Irving, Texas; Center for Advanced Cardiovascular Care, The Heart Hospital Baylor Plano, Plano, Texas.
Ann Thorac Surg. 2017 Dec;104(6):1987-1993. doi: 10.1016/j.athoracsur.2017.05.046. Epub 2017 Aug 30.
Risk-adjusted operative mortality is the most important quality metric in cardiac surgery for determining The Society of Thoracic Surgeons (STS) Composite Score for star ratings. Accurate 30-day status is required to determine STS operative mortality. The goal of this study was to determine the effect of unknown or missing 30-day status on risk-adjusted operative mortality in a regional STS Adult Cardiac Surgery Database cooperative and demonstrate the ability to correct these deficiencies by matching with an administrative database.
STS Adult Cardiac Surgery Database data were submitted by 27 hospitals from five hospital systems to the Texas Quality Initiative (TQI), a regional quality collaborative. TQI data were matched with a regional hospital claims database to resolve unknown 30-day status. The risk-adjusted operative mortality observed-to-expected (O/E) ratio was determined before and after matching to determine the effect of unknown status on the operative mortality O/E.
TQI found an excessive (22%) unknown 30-day status for STS isolated coronary artery bypass grafting cases. Matching the TQI data to the administrative claims database reduced the unknowns to 7%. The STS process of imputing unknown 30-day status as alive underestimates the true operative mortality O/E (1.27 before vs 1.30 after match), while excluding unknowns overestimates the operative mortality O/E (1.57 before vs 1.37 after match) for isolated coronary artery bypass grafting.
The current STS algorithm of imputing unknown 30-day status as alive and a strategy of excluding cases with unknown 30-day status both result in erroneous calculation of operative mortality and operative mortality O/E. However, external validation by matching with an administrative database can improve the accuracy of clinical databases such as the STS Adult Cardiac Surgery Database.
风险调整后的手术死亡率是心脏手术中用于确定胸外科医师协会（STS）星级评定综合评分的最重要质量指标。确定STS手术死亡率需要准确的30天状态信息。本研究的目的是确定在一个地区性STS成人心脏手术数据库合作项目中，未知或缺失的30天状态对风险调整后的手术死亡率的影响，并证明通过与行政数据库匹配来纠正这些缺陷的能力。
来自五个医院系统的27家医院向地区质量合作项目德克萨斯质量倡议（TQI）提交了STS成人心脏手术数据库数据。TQI数据与地区医院理赔数据库进行匹配，以解决未知的30天状态问题。在匹配前后确定风险调整后的手术死亡率观察值与预期值（O/E）之比，以确定未知状态对手术死亡率O/E的影响。
TQI发现STS单纯冠状动脉搭桥术病例中有22%的30天状态未知。将TQI数据与行政理赔数据库匹配后，未知率降至7%。将未知的30天状态推算为存活的STS流程低估了真实的手术死亡率O/E（匹配前为1.27，匹配后为1.30），而排除未知状态则高估了单纯冠状动脉搭桥术的手术死亡率O/E（匹配前为1.57，匹配后为1.37）。
当前将未知的30天状态推算为存活的STS算法以及排除30天状态未知病例的策略，都会导致手术死亡率和手术死亡率O/E的计算错误。然而，通过与行政数据库匹配进行外部验证可以提高临床数据库（如STS成人心脏手术数据库）的准确性。
