In its ongoing, multidecade quest to optimize patient outcomes in adult and congenital cardiothoracic surgery, The Society of Thoracic Surgeons (STS) has emphasized several key strategies, including quality measurement, feedback reports to providers, performance improvement initiatives, clinical research, and public reporting. The foundation for all these activities is the STS National Database, a gold standard clinical registry with more than 3 decades of operational experience, continuing evolution, nearly universal (≈ 97%) penetration among US adult cardiac programs, and annual program audits demonstrating 96% to 97% data accuracy.