– PERFORMANCE MEASURES –
Society of Thoracic Surgeons (STS)

The Society of Thoracic Surgeons has contributed to cardiac surgery performance measures, beginning with its participation in the NQF Consensus Measures process. The STS had several participating members in the both the Steering Committee and Technical Advisory Panel (TAP) in that process. The STS' strong voice in that process was bolstered by years of experience and understanding of outcomes gathered from the STS National database.

Cardiac Surgery Performance Measures

• •  NQF National Voluntary Consensus Standards for Cardiac Surgery

  The STS was a primary participant in the development of the NQF National Voluntary Consensus Standards for Cardiac Surgery [PDF] that was approved in October 2004. These 21 cardiac surgery measures were formulated in an NQF process that evaluated over 100 measures by representives of CMS, The Leapfrog Group, STS, ACC, JCAHO, individual cardiac healthcare providers, and a myriad of NQF members. While measures from several sources were evaluated, the contributing sources (and number of measures) for the 21 NQF-endorsed measures include the STS (14), CMS (5), CMS-QIOs (1), and the California CABG Outcome Reporting Program - CCORP (1).

• •  NQF National Voluntary Consensus Standards for Hospital Care

  The NQF also endorsed 6 measures that apply to cardiac surgery among the 39 NQF National Voluntary Consensus Standards for Hospital Care [PDF] that were released in 2003 (and upgraded in 2006). Utilization of Internal Mammary artery grafts with CABG surgery was contributed by CMS, and the three antibiotic measures reflect input from the Surgical Infection Prevention (SIP) initiative that was promoted since 2000 by CMS in its contracts with Quality Improvement Organizations and that have transitioned into Surgical Care Improvement Project (SCIP) in 2006. Except for modification of the duration of antibiotics extending to 48 hours for cardiac surgery, these measures are otherwise identical across all surgeries.

  The other two measures are not primary cardiac surgery measures but were adopted as two of the 13 Acute Coronary Syndrome performance measures in this NQF National Voluntary Consensus Standards for Hospital Care. One cardiac surgery measure is a CMS measure of CABG volume (using hospital administrative database methodology), and the second is risk-adjusted CABG mortality, using the New York Cardiac Surgery Reporting System logistic regresion model.

• •  AQA Cardiac Surgery Performance Measures

  The Ambulatory Care Quality Alliance (AQA) also announced adoption of the Cardiac surgery performance measures "starter-set" at its April 2006 meeting. The AQA cardiac surgery measures are a subset of 15 of the 21 NQF cardiac surgery measures. A list of performance measures by set of measures is provided in the table below.

Performance Measures in Cardiac Surgery Measurement Sets

Performance Measure Clinical Topic			Peformance Measure Sets
			NQF National Consensus Standards				AQA Starter Set Cardiac Surgery
			Cardiac Surgery		Hospital Care
1.	Participation in a systematic database for cardiac surgery	X	–	X
2.	Surgical volume for isolated coronary artery bypass graft (CABG) surgery, valve surgery, and CABG+valve surgery	X	–	–
3.	Timing of antibiotic administration for cardiac surgery patients	X	X	X
4.	Selection of antibiotic administration for cardiac surgery patients	X	X	X
5.	Pre-operative beta blockade	X	–	X
6.	Use of internal mammary artery	X	X	X
7.	Duration of prophylaxis for cardiac surgery patients	X	X	X
8.	Prolonged intubation	X	–	X
9.	Deep sternal wound infection rate	X	–	X
10.	Stroke/cerebrovascular accident	X	–	X
11.	Post-operative renal insufficiency	X	–	X
12.	Surgical re-exploration	X	–	X
13.	Anti-platelet medications at discharge	X	–	X
14.	Beta blockade at discharge	X	–	X
15.	Anti-lipid treatment at discharge	X	–	X
16.	Risk-adjusted inpatient operative mortality for CABG	X	–	–
17.	Risk-adjusted 30-day operative mortality for CABG	X	–	X
18.	Risk-adjusted 30-day operative mortality for aortic valve replacement (AVR)	X	–	–
19.	Risk-adjusted 30-day operative mortality for mitral valve replacement/repair (MVR)	X	–	–
20.	Risk-adjusted 30-day operative mortality for MVR+CABG	X	–	–
21.	Risk-adjusted 30-day operative mortality for AVR+CABG	X	–	–
TOTALS		21	4	15