The Society of Thoracic Surgeons Practice Guidelines Fred H. Edwards, MD, and T. Bruce Ferguson, MD Division of Cardiothoracic Surgery, University of Florida/Shands Jacksonville, Jacksonville, Florida, and the Departments of Surgery and Physiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana E vidence-based practice guidelines have become commonplace in the last few years. For readers of this journal, probably the most well known are the American College of Cardiology/American Heart Association guidelines. These guidelines cover some topics of interest to thoracic surgeons, but with the possible exception of the American College of Cardiology/American Heart Association guideline on coronary artery bypass grafting surgery, the treatment of surgical topics is fairly superficial. Clearly there is a need for practice guidelines developed by thoracic surgeons for thoracic surgeons. In this issue, The Society of Thoracic Surgeons (STS) presents the first in a new series of practice guidelines [1]. These STS guidelines will be developed by the Workforce on Evidence-Based Surgery and will be extensively reviewed at several levels within the STS leadership before publication. gestible. Topics in both cardiac and general thoracic surgery will be addressed. In general we will avoid broad topics, favoring instead more focused topics that are meaningful, practical, and controversial. The Workforce on Evidence-Based Surgery chair will appoint a taskforce responsible for developing each guideline. This taskforce will exhaustively search the literature to gather all published information on the selected topic. The evidence will then be impartially interpreted and the findings incorporated into a practice guideline document. That document will then be critiqued by the membership of the Workforce on Evidence-Based Surgery and passed for further review to the Operating Board of the Council on Quality Assurance and Patient Advocacy. The finalized guideline will then be submitted to The Annals of Thoracic Surgery for editorial review before publication. Purpose Application Our intent is to provide a service to STS members. In recent years the sheer volume of surgical literature has undergone explosive growth, thereby making it extraordinarily difficult to stay abreast of current issues. Practice guidelines should save the busy surgeon from timeintensive literature reviews. Ideally, patient management is largely governed by Our intent is to produce an unbiased document that serves as a clinical guide for thoracic surgeons. We specifically do not propose to dictate patient management, and we do not presume that these guidelines describe the only acceptable clinical approaches. Eventually, we anticipate that the combination of these guidelines with the process and outcomes measures collected in the STS national databases will create the opportunity to assess the appropriateness of cardiac and thoracic surgical care: “the right thing was done right at the right time in the patient’s disease process.” It therefore seems appropriate that the STS guidelines should be carefully considered by the membership. These guidelines represent the work of surgical and medical experts and have been subjected to detailed scrutiny by numerous critical reviews. This process of development and review is specifically designed to obviate the bias that is often seen in published reviews from a single source. The guidelines are endorsed by the STS and should be considered as one acceptable approach to patient management. See page 1494 our interpretation of published scientific evidence. We all know, however, that it is hard not to be influenced by our recent experiences, our training, or our common standby: “That’s how I’ve always done it.” The STS guidelines are to be based solely on the published evidence, and may provide valuable assistance in countering some of these subjective influences. The guidelines are intended to provide real guidance in determining optimal patient management. Each guideline will present an evidence table, which will contain firm practical recommendations along with an assessment of the evidence that supports each recommendation. Approach Recognizing that some guidelines are so large as to be unwieldy, we will create documents that are easily diAddress reprint requests to Dr Edwards, Division of Cardiothoracic Surgery, University of Florida/Shands Jacksonville, 655 West 8th St, Jacksonville, FL 32209; e-mail: fhe@comcast.net. © 2004 by The Society of Thoracic Surgeons Published by Elsevier Inc Distribution After completion of the review process, most guidelines will be posted on a Web page within the sts.org Web site. Input from STS members will be solicited to provide the membership with an opportunity to participate in the process. After 1 month, the comments will be evaluated and the document may be revised to accommodate Ann Thorac Surg 2004;77:1140 –1 • 0003-4975/04/$30.00 doi:10.1016/j.athoracsur.2004.01.006 Ann Thorac Surg 2004;77:1140 –1 membership feedback. At that point, the guideline will be published both on the Web site and in The Annals of Thoracic Surgery. All guidelines will undergo annual reviews to assess the need for updates. EDITORIAL EDWARDS AND FERGUSON STS PRACTICE GUIDELINES 1141 dictate, but rather suggest, patient management strategies. We hope that the guidelines will provide a useful service helping STS members to save time and to clear the fog associated with many controversial issues in our field. Conclusions We anticipate that these guidelines will facilitate clinical practice by providing an evidence-based analysis of practical issues in cardiothoracic surgery. These guidelines will present firm recommendations for patient care, but all parties should recognize that the guidelines do not Reference 1. Bridges CR, Horvath KA, Nugent WC, et al. The Society of Thoracic Surgeons Practice Guideline Series: Transmyocardial Laser Revascularization. Ann Thorac Surg 2004;77:1494 – 502.