CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 3, May/June 2010
AFRICA
153
Cardiovascular Topics
A South African national database in cardiothoracic
surgery
ANTHONY LINEGAR, FRANCIS SMIT, ANDRIE STROEBEL, ELIZABETH SCHAAFSMA
Summary
This article aims to update South African cardiothoracic
surgeons on the developmental progress of the national
database in cardiac and thoracic surgery and to encourage
participation in this most important endeavour.
Keywords:
national database, cardiothoracic surgery, South
Africa
Submitted 8/12/09, accepted 10/3/10
Cardiovasc J Afr
2010;
21
: 153–154
The role of databases in evidence-based
cardiothoracic surgery
Cardiothoracic surgery in the academic units of South Africa
faces challenges on two fronts; to keep pace with international
developments in cardiothoracic surgery and simultaneously to
survive the trials of a healthcare service in crisis.
1
Both involve
the need to meet the growing demand for service from the
profession and the public, and to increase the evidence basis in
clinical decision making.
2
Evidence-based medicine (EBM) has been described as the
judicious combination of best external evidence, integrated with
the clinician’s clinical experience and insight.
3
Its philosophy is
to minimise intuitive decision making and to replace anecdotal
dogma with a clear treatment plan individualised to the patient’s
circumstances, without substituting clinical insight for inflex-
ibility.
Databases perform two broad functions; one is specifically
designed to collect data in answer to a specific research ques-
tion involving a series of patients, and the other is a prospective
continual recording of a wide range of data on all patients treated
by a speciality, for later use in clinical and healthcare systems
research. Databases therefore provide the basis on which to
convert information into knowledge that guides clinical prac-
tice.
4
Analysis of accurately collected data allows the interpretation
of outcomes of treatment, provides information for prognostica-
tion and identifies factors that influence outcome in subsets of
patients or operations. Trends, strengths and weaknesses that
emerge from this process will facilitate strategic planning and
advocacy with health policy makers in resource allocation, train-
ing requirements and speciality development.
5,6
A national database is therefore an important asset to cardio-
thoracic surgery in South Africa.
Design features of the database
The South African National Cardiothoracic Surgery database
was written by eMD
®
on an IBM Lotus platform and uses XML
and Java Scripting. eMD
®
will continue to provide programming
assistance and maintenance on code-related issues.
Data entry fields are based on the Society for Thoracic
Surgeons (STS) database (SND) with necessary adaptations
for local relevance.
7
It is designed on the principle of minimal
free-hand data entry, using pull-down windows to select prede-
termined options, but where appropriate, free-text data entry
fields, e.g. for operation notes, are included. It has the ability
to export information on selected subsets of patients for deeper
statistical analysis.
Field description
Data entry begins with patient demographics. The patient’s
national identity (ID) number prevents duplication of patient
files. In the case of a paediatric patient without a national ID
number, the date of birth serves this function. A unique, chrono-
logical identification number is automatically allocated to each
patient for the filing of hard-copy patient folders.
Sections on history and clinical examination follow this, and
include risk factors in cardiac and thoracic surgery. Thereafter
come sections on special examinations such as electrocardio-
gram, lung functions, echocardiography and radiological investi-
gations. The intention is to add digital radiological images in the
future. Finally, it records outcome data, complications, mortality
and discharge data including medications and follow-up plans.
The program also contains a complete practice management
system with tariff and ICD 10 codes and software to interface
with the medical aid industry. It provides accounting details
for tracking debtors, performing audit trails and monthly aged
analysis.
Report generation
Generation of clinical reports is individualised to specific user
requirements using any combination of field variables. It can,
Department Cardiothoracic Surgery, University of the Free
State, Bloemfontein, South Africa
ANTHONY LINEGAR, MB ChB, FC (Cardio) SA, PhD,
FRANCIS SMIT, MB ChB, MMed (Cardiothor)
ANDRIE STROEBEL, MB ChB
South African Heart Association, Department of Cardiology,
Tygerberg Hospital, Cape Town, South Africa
ELIZABETH SCHAAFSMA, BSc (Hons)
