TY - JOUR
T1 - Estimating mortality risk for adult congenital heart surgery
T2 - An analysis of the society of thoracic surgeons congenital heart surgery database
AU - Fuller, Stephanie M.
AU - He, Xia
AU - Jacobs, Jeffrey P.
AU - Pasquali, Sara K.
AU - Gaynor, J. William
AU - Mascio, Christopher E.
AU - Hill, Kevin D.
AU - Jacobs, Marshall L.
AU - Kim, Yuli Y.
N1 - Publisher Copyright:
© 2015 The Society of Thoracic Surgeons.
PY - 2015/11
Y1 - 2015/11
N2 - Background Adjustment for case mix is critical to accurate outcomes analysis in congenital heart surgery. Established tools encompass all age groups and are not specific to the growing population of adults undergoing congenital heart operations. We derived an empirically based adult congenital heart surgery (ACHS) mortality score. Methods In-hospital mortality was analyzed for the 152 most common procedures/procedural groups in adults 18 years of age and older in The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) (2000-2013). Procedure-specific adult mortality rate estimates were calculated using Bayesian methods adjusting for small denominators for procedures with 30 cases or more (N = 52). Each procedural group was assigned an ACHS mortality score ranging from 0.1 to 3.0 based on the estimated mortality rate. Discrimination was assessed using the c-index in a separate validation sample. Results A total of 12,513 procedures (116 centers) were analyzed. Overall unadjusted mortality was 1.8%. Significant differences in mortality rates in adults compared with all ages were seen for several procedures, including Ebstein's repair (0.7% versus 4.9%; p = 0.003) and Fontan operations (6.8% versus 1.4%; p < 0.01). The procedure with the lowest model-based estimate of mortality and accompanying ACHS mortality score was atrial septal defect repair (0.2%, 0.1), and the highest was Fontan revision (9.7%, 3.0). The c-index for the ACHS mortality score was 0.809 versus 0.777 for the "non-age-specific" Society of Thoracic Surgeons-European Association for Cardio-thoracic Surgery (STAT) mortality score applied to adults. Conclusions Risk estimation based on the aggregate of all age groups is suboptimal when analyzing outcomes specifically among adults. An empirically based ACHS mortality score can facilitate case-mix adjustment by providing accurate estimation of mortality risk for adults.
AB - Background Adjustment for case mix is critical to accurate outcomes analysis in congenital heart surgery. Established tools encompass all age groups and are not specific to the growing population of adults undergoing congenital heart operations. We derived an empirically based adult congenital heart surgery (ACHS) mortality score. Methods In-hospital mortality was analyzed for the 152 most common procedures/procedural groups in adults 18 years of age and older in The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) (2000-2013). Procedure-specific adult mortality rate estimates were calculated using Bayesian methods adjusting for small denominators for procedures with 30 cases or more (N = 52). Each procedural group was assigned an ACHS mortality score ranging from 0.1 to 3.0 based on the estimated mortality rate. Discrimination was assessed using the c-index in a separate validation sample. Results A total of 12,513 procedures (116 centers) were analyzed. Overall unadjusted mortality was 1.8%. Significant differences in mortality rates in adults compared with all ages were seen for several procedures, including Ebstein's repair (0.7% versus 4.9%; p = 0.003) and Fontan operations (6.8% versus 1.4%; p < 0.01). The procedure with the lowest model-based estimate of mortality and accompanying ACHS mortality score was atrial septal defect repair (0.2%, 0.1), and the highest was Fontan revision (9.7%, 3.0). The c-index for the ACHS mortality score was 0.809 versus 0.777 for the "non-age-specific" Society of Thoracic Surgeons-European Association for Cardio-thoracic Surgery (STAT) mortality score applied to adults. Conclusions Risk estimation based on the aggregate of all age groups is suboptimal when analyzing outcomes specifically among adults. An empirically based ACHS mortality score can facilitate case-mix adjustment by providing accurate estimation of mortality risk for adults.
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U2 - 10.1016/j.athoracsur.2015.07.002
DO - 10.1016/j.athoracsur.2015.07.002
M3 - Article
C2 - 26411754
AN - SCOPUS:84946471698
SN - 0003-4975
VL - 100
SP - 1728
EP - 1736
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 5
ER -