STS 2.73 : New IntraOp Data

The Great Migration to v 2.73 : 

(New STS Fields)

Click Image to View entire 2.73 Series

The following post  describes the new fields that are identified as new data collection points in the  STS v. 2.73 Adult Cardiac Database.

(Customized PowerPoint Template for Perfusion STS Data Collection)

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Customized STS Form (for Perfusion)

Overall assessment:

Summarizing this section is simple.  Real Time Data!

The Hybrid issue is relatively easy to capture- if you are in the mix on the day of surgery, but can easily be missed when abstracting a patient chart.

The Valve and Graft data sections are a 10 fold increase in terms of the clinical sophistication of the data they secure.  There is no way this data can be captured except during the case !

The anatomical information is far too sophisticated to relegate to memory (major fail if you try this) or to extract from an Operative Note no matter how detailed that note is.

New IntraOp Data

CABG Data x 10 (possible number of vessels)

The Image above says it all.  (click to enlarge)

• Identify Vessel to be bypassed (LAD, Cx, OM, Diag, PDA)
• Identify Caliber of Stenosis
• Identify Prox Insertion Site (Aorta or other sites if Aorta is Calcified)
• Identify Prox Anastamosis Technique (Running, Interrupted, Device)
• Identify whether Endarterectomy was performed
• Identify Distal Target
• Identify end-to-end versus sequential grafting

CABHybrPCI

Indicate whether a hybrid coronary surgical and interventional cardiology procedure was performed.

Options available for treatment of multivessel coronary artery disease may include a combined procedure. Stenting, performed by a cardiologist, combined with grafting, performed by a surgeon.

HybrStat

Indicate Status of Hybrid procedure.

• -Planned – concurrent Planned, performed same setting
• -Planned – staged Planned, performed same hospital admission
• -Unplanned -Unplanned, performed after incomplete revascularization or graft closure during the same hospital admission

HybrProc

Indicate PCI Procedure performed.

Indicate which Percutaneous Coronary Intervention (PCI) was performed as part of the hybrid procedure.

• -Angioplasty
• -Stent

SaphHrvstT

Indicate the total time in minutes for saphenous vein harvest-from the time the skin incision is made until the vein is out.

It is important to quantify the harvest and prep times to track resource utilization and provide objective data for RUC surveys and coding.

This is important because these values determine the rate at which Medicare and other payers reimburse for procedures.

SaphPrepT

Indicate the time needed to prepare the harvested graft, from removal until suitable for use.

It is important to quantify the harvest and prep times to track resource utilization and provide objective data for RUC surveys and coding.

This is important because these values determine the rate at which Medicare and other payers reimburse for procedures.

RadHrvstT

Indicate the total time in minutes for radial artery harvesting-from the time the skin incision is made until the conduit is out.

It is important to quantify the harvest and prep times to track resource utilization and provide objective data for RUC surveys and coding.

This is important because these values determine the rate at which Medicare and other payers reimburse for procedures.

RadPrepT

Indicate the time needed to prepare the harvested graft, from removal until suitable for use.

It is important to quantify the harvest and prep times to track resource utilization and provide objective data for RUC surveys and coding.

This is important because these values determine the rate at which Medicare and other payers reimburse for procedures.

NoIMARsn

Indicate the primary reason the IMA was not used as a bypass conduit.

Choose from the following reasons:

• -The IMA is not a suitable conduit due to size or flow- The National Quality Forum (NQF) does not consider this exclusion for measure purposes.
• -Subclavian stenosis
• -Previous cardiac or thoracic surgery
• -Previous mediastinal radiation
• -Emergent or salvage procedure
• -No (BYPASSABLE) LAD disease- This can include clean LAD, diffusely diseased LAD or other condition resulting in the LAD not being bypassed

Aortic Valve

Indicate procedure performed on aortic valve and/or ascending aorta.

• -Replacement
• -Repair / Reconstruction
• -Root Reconstruction with valved conduit
• -Replacement and insertion aortic non-valved conduit
• -Resuspension AV without replacement of ascending aorta
• -Resuspension AV with replacement of ascending aorta
• -Apico-aortic conduit (Aortic valve bypass)
• -Autograft with pulmonary valve- Ross procedure
• -Homograft
• -Valve sparing root reimplantation (David)
• commissural annuloplasty
• ring annuloplasty
• leaflet plication
• leaflet resection
• leaflet free edge reinforcement (PTFE) suture
• leaflet pericardial patch
• leaflet commissural resuspension suture
• leaflet debridement
• division of fused leaflet raphe

• Transcatheter valve
• Transapical
• Transaxillary
• Transfemoral

Mitral Valve

• annuloplasty
• leaflet repair
• Anterior
• Posterior
• Both

• sliding plasty
• annular decalcification
• procedure included neochords (PTFE).
• Number of Neochords _______

• chordal / leaflet transfer
• leaflet extension/ replacement / patch
• edge to edge repair
• mitral commissurotomy