The Society of Thoracic Surgeons (STS) National Database is a voluntary clinical registry created to facilitate a national quality improvement and safety initiative for cardiac surgery. This progressive initiative led to one of the earliest attempts to provide surgeons with nationally benchmarked, risk-adjusted outcomes. The database (Box) is now also used to facilitate the public reporting of outcomes and clinical research. It consists of 3 components, each focusing on a separate type of cardiothoracic surgery: adult cardiac surgery (established 1989), congenital heart surgery (1994), and general thoracic surgery (2002). Since 1999, the STS has contracted the Duke Clinical Research Institute to warehouse the data, conduct statistical analyses, and provide participants with performance reports.