STS-CCAS Database Update
April, 2010
By David F. Vener, MD
Database Committee Chair
To all who missed the CCAS – SPA meeting in San Antonio: it was a great event with excellent speakers and a large turnout with interesting topics. Emad Mossad and Anshuman Sharma put together a really well-rounded program with a nice balance of clinical and research issues of specific relevance to our subspecialty. At lunchtime I was given the opportunity to bring the attendees up-to-date on the current status of our database and later on Thursday evening the members of the database committee met for the first time to review our progress to date and current and future issues that we will have to address.
Our committee meeting is open, with participants and input welcome from any interested parties. For those working on these databases, another meeting I highly suggest attending is the annual STS Advances in Quality and Outcomes meeting (http://www.sts.org/sections/stsnationaldatabase/advances/) where data managers from around the country discuss the finer points of the various databases. There is a breakout session for the congenital database that might be very informative as anesthesiologists begin inputting data – although the AQO meeting is geared towards data personnel, it can and does have some physician and nursing participation.
The STS-CCAS Congenital Cardiac Database v 3.0 went “live” on January 1, 2010. This was a major step forward, but is only the first one in a long process. All of the database vendors certified by the STS for v 3.0 (CardioAccess, Lumedx, Axis, Cedaron, heartbase and CAOS) have released their updates incorporating all of the new data fields, including anesthesia. Many congenital heart programs however are still working out the kinks and may not yet have fully incorporated all the updates – it is critical that you communicate with your surgical colleagues about your participation, especially in regards to IRB and manpower issues.
Topics of discussion that came up in San Antonio included the following:
- IRB notification and permission: Although the STS has maintained that the database is a Quality Initiative and thus exempt from individual institutional IRB oversight, many medical school and hospital IRBs have not agreed with this argument and have asked for a variety of hoops for departments to jump through before submitting data. A major concern is the transmission of confidential patient information such as patient and family names and social security numbers that are critical to generating a Unique Patient Identifier that will follow a patient throughout their cardiac care.
- Data points: The congenital database undergoes a “major” update every three years. As we begin to enter data into the anesthesia fields we are asking participants to provide feedback about either new data points they would like added or editing or deleting existing data points. Changes suggested so far include adding Ultrasound Guidance utilization for line placement, Skin/Integument breakdown under complications, and revisions to the drug list.
- Setting up a CCAS research and publications review process that would screen research applications to the database to minimize unnecessary data mining and prioritize data queries if we are limited in the number of projects that can be handled by DCRI.
Another area of interest is finding out who is participating in the anesthesia database. The business agreements between DCRI and STS and individual programs went out in March, 2010 for the Spring 2011 data harvest. Until the data is submitted next year, there is no way to estimate how many centers will be participating and how many patients will be submitted. Anesthesia participation will require signatures from all members of the anesthesia departments that provide care for CV patients. The fee for anesthesia participation ($3000/yr) will be bundled into the surgical bill and is not a separate fee. It is to be paid directly to the STS and does not come through the CCAS offices.
This project will bring LOTS of questions and I anticipate that the first years will be a learning process for all of us but I am confident that improved patient information and outcomes are worth this initial turbulence. Please feel free to contact me with any questions, suggestions or complaints: vener@bcm.edu
