Initial application in the EACTS and STS congenital heart surgery databases of an empirically derived methodology of complexity adjustment to evaluate surgical case mix and results

Jeffrey Phillip Jacobs, Marshall Lewis Jacobs, Bohdan Maruszewski, Francois G. Lacour-gayet, Christo I. Tchervenkov, Zdzislaw Tobota, Giovanni Stellin, Hiromi Kurosawa, Arata Murakami, J. William Gaynor, Sara K. Pasquali, David R. Clarke, Erle H. Austin, Constantine Mavroudis

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Outcomes evaluation is enhanced by assignment of operative procedures to appropriate categories based upon relative average risk. Formal risk modelling is challenging when a large number of operation types exist, including relatively rare procedures. Complexity stratification provides an alternative methodology. We report the initial application in the Congenital Heart Surgery Databases of the Society of Thoracic Surgeons (STS) and the European Association for Cardio-thoracic Surgery (EACTS) of an empirically derived system of complexity adjustment to evaluate surgical case mix and results. Methods: Complexity stratification is a method of analysis in which the data are divided into relatively homogeneous groups (called strata). A complexity stratification tool named the STS-EACTS Congenital Heart Surgery Mortality Categories (STAT Mortality Categories) was previously developed based on the analysis of 77 294 operations entered in the Congenital Heart Surgery Databases of EACTS (33 360 operations) and STS (43 934 patients). Procedure-specific mortality rate estimates were calculated using a Bayesian model that adjusted for small denominators. Operations were sorted by increasing risk and grouped into five categories (the STAT Mortality Categories) that were designed to minimize within-category variation and maximize between-category variation. We report here the initial application of this methodology in the EACTS Congenital Heart Surgery Database (47 187 operations performed over 4 years: 2006-09) and the STS Congenital Heart Surgery Database (64 307 operations performed over 4 years: 2006-09). Results: In the STS Congenital Heart Surgery Database, operations classified as STAT Mortality Categories 1-5 were (1): 17332, (2): 20114, (3): 9494, (4): 14525 and (5): 2842. Discharge mortality was (1): 0.54%, (2): 1.6%, (3): 2.4%, (4): 7.5% and (5): 17.8%. In the EACTS Congenital Heart Surgery Database, operations classified as STAT Mortality Categories 1-5 were (1): 19874, (2): 12196, (3): 5614, (4): 8287 and (5): 1216. Discharge mortality was (1): 0.99%, (2): 2.9%, (3): 5.0%, (4): 10.3% and (5): 25.0%. Conclusions: The STAT Mortality Categories facilitate analysis of outcomes across the wide spectrum of distinct congenital heart surgery operations including infrequently performed procedures.

Original languageEnglish (US)
Article numberezs026
Pages (from-to)775-780
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume42
Issue number5
DOIs
StatePublished - Nov 2012
Externally publishedYes

Keywords

  • Database
  • Outcomes
  • Quality assessment
  • Quality improvement

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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