A new digital tool launched by the Society of Thoracic Surgeons (STS) draws together data from more than 8 million procedures collected through the Society’s Adult Cardiac Surgery Database to power decision-making on surgical risk.
According to STS president Thomas MacGillivray (MedStar Heart and Vascular Institute, Washington DC, USA), the Society’s new Operative Risk Calculator, launched in July, will provide a vital tool in counselling patients on their potential procedural risk, as well as making it easier for surgeons to assess risk at the bedside.
“The previous calculator that we had was very good, but it was a little bit clunky,” MacGillivray tells Cardiovascular News. Through the previous generation, users would need access to a desktop computer and were required to fill out several pages of information. The new-generation risk calculator has all of the information contained on one page and is compatible with mobile devices, making it more user-friendly, according to the STS president.
The risk calculations are based on the most current nationwide data from the STS Adult Cardiac Surgery Database and these are informed by robust risk models that continuously update every three months, down from every few years under the previous model.
MacGillivray comments that having access to a more up-to-date pool of data will mean that users can be more adaptive based upon evolving trends in the treatment of patients with heart disease.
“The practice of cardiac surgery is changing. With transcatheter therapies, there is less [surgical] aortic valve replacement. Patients who get an aortic valve replacement are different now because most of the patients get a transcatheter valve replacement,” he explains. “With the data and risk models being updated more frequently, you get a more accurate set of data compared to if you had to wait for that every few years.”
Harnessing data will have a positive impact in the way that surgeons are able to communicate surgical risk to their patients, MacGillivray adds, commenting that this is among the benefits of drawing upon real-world information.
“I know from my own practice that if somebody comes in to talk about surgery they are very nervous, and their imagination has run wild. So when you do these risk calculators and you show them what their risk is they are quite often relieved and surprised that the risk is as low as it is.
“That is probably one of the greatest benefits of it, that you can both inform the patient with some objective information, and you can reassure the patient and their family with that information and knowing that it is accurate.”
Updates to the risk calculator are the culmination of a long-term project initiated by the STS, which has taken on board the needs of members who use the tool and the database. The organisation has also taken over the management of its database in-house, where previously it was hosted by the Duke Clinical Research Institute.
“In the past we were somewhat dependent on other organisations to be the keepers of our data and to run the data model; we were on their timeline. With the changes, we are now in control of that and we can set the pace, and that is what has allowed us to facilitate these changes,” says MacGillivray.
Further work is being undertaken to enhance the STS National Database, with several changes expected to roll out in the coming months. Specific projects will include risk models for adult congenital heart disease, patients undergoing multiple procedures, and aortic surgery.
