Ethical issues confronting outcomes analysis and quality assurance

The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) has served as the primary, externally validated source for outcomes from its many participating centers. Because participation is voluntary and data are not publically reported, there exists a fundamental conflict with the overwhelming trend toward public reporting in both medicine and cardiac surgery. The ethical issues surrounding this conflict, as well as those involved in public reporting of complex congenital heart disease in general are described herein. The process by which adult cardiac surgery has come to initiate public reporting, while an important model for future directions in outcome reporting, does not adequately address the unique challenges that are faced by the reporting of congenital heart surgical outcomes. If these ethical issues are addressed and public reporting can be done in a responsible manner, then it should be undertaken by the leadership of physician-based groups such as the Society of Thoracic Surgeons.