Contributor: Faisal Bakaeen, MD
You likely know you can reduce your chance of heart disease if you can stop smoking, exercise more and adopt a healthy diet. Likewise, if you have heart disease
and need surgery, you can reduce risks and increase the likelihood of a good outcome.
You can get medical issues — like diabetes, high blood pressure
and high cholesterol
— under control before you have surgery. And you can choose a hospital that has good ratings for your particular condition.
One group that can help you determine the best hospital for your needs is the Society of Thoracic Surgeons
(STS). Here’s some information about how the society’s public reporting data works.
Why is public reporting important?
The goal of collecting and reporting data on the effectiveness of cardiac surgery
programs is to make all programs better. The effort sets benchmarks that hospitals can aim for to improve their quality. The information also can give you an idea of where your local hospital ranks among others nearby and across the country.
The STS’s Adult Cardiac Surgery Database compiles millions of records to cover about 95 percent of the surgical groups in the nation. Hospitals that participate update throughout the year, so the data is current.
The database reports on coronary artery
bypass grafting, isolated aortic valve replacement
and a combination. The group plans to add mitral valve replacement and repair
How are hospital cardiac programs rated?
Information is provided through a star ranking system, with three the best and one the worst. Only one in 10 or less of programs get three stars and most of the rest receive two stars. A small number end up with fewer than two.
The rating system tracks data in these categories:
- Mortality — meaning the percentage of patients who survive the surgery
- Morbidity — the percentage of patients who leave the hospital without major complications such as stroke, kidney failure, infection at the surgical site or re-operation
- Use of mammary artery — the percentage of patients who received this preferred artery for a graft
- How often doctors prescribed the four medications believed to improve a patient’s immediate and long-term outcomes, before, during and after surgery
Each program receives a composite score based on the these rankings.
If a hospital you are considering does not report their information on the site, it is likely they still participate in the survey. You can ask for their information and if they don’t provide it, that is sometimes a red flag.
Adjusting risk for more accurate data
One important factor that makes the STS database reliable is that it risk-adjusts when tallying each category.
This reflects the fact that all programs operate on different types of patients — some may specialize in high-risk cases and some may see healthier patients.
This, of course, is going to have an impact on outcomes and could skew results. But the society’s data adjusts for factors like a patient’s age, procedure, co-existing conditions and prior surgeries. This tends to provide clearer, more accurate data.
Data models can’t necessarily predict your individual risk
Even though the scores are risk-adjusted, it’s important to remember that if 90 percent of patients at a particular hospital had surgery without any complications that doesn’t mean you have a 90 percent chance as well.
Models like the society’s are best used to help understand what the average risk is for patients undergoing similar treatment. They aren’t designed to predict individual risk, but rather group risk.
The purpose is to understand if your individual risk is low, medium or high at a particular institution. The scores are best used to begin discussions on benefits and risks of surgery with your family and health care provider.