TY - JOUR
T1 - Stratification of complexity improves the utility and accuracy of outcomes analysis in a multi-institutional congenital heart surgery database
T2 - Application of the Risk Adjustment in Congenital Heart Surgery (RACHS-1) and Aristotle systems in the Society of Thoracic Surgeons (STS) congenital heart surgery database
AU - Jacobs, Jeffrey P.
AU - Jacobs, Marshall L.
AU - Lacour-Gayet, Francois G.
AU - Jenkins, Kathy J.
AU - Gauvreau, Kimberlee
AU - Bacha, Emile
AU - Maruszewski, Bohdan
AU - Clarke, David R.
AU - Tchervenkonv, Christo I.
AU - Gaynor, J. William
AU - Spray, Thomas L.
AU - Stellin, Giovanni
AU - O'Brien, Sean M.
AU - Elliott, Martin J.
AU - Mavroudis, Constantine
N1 - Funding Information:
We thank the Children’s Heart Foundation ( http://www.childrensheartfoundation.org/ ) for financial support of this research.
PY - 2009/11
Y1 - 2009/11
N2 - Quality-of-care evaluation must take into account variations in "case mix." This study reviewed the application of two case-mix complexity-adjustment tools in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database: the Aristotle Basic Complexity (ABC) score and the Risk Adjustment in Congenital Heart Surgery (RACHS-1) method. The 2006 STS Congenital Heart Surgery Database Report, the first STS report to incorporate both methods, included 45,635 operations from 47 centers. Each operation was assigned an ABC score in a range from 1.5 (lowest complexity) to 15 (highest complexity), an ABC level in a range from 1 (lowest complexity) to 4 (highest complexity), and a RACHS-1 category in a range from 1 (lowest risk) to 6 (highest risk). The overall discharge mortality was 3.9% (1,222/31,719 eligible cardiac index operations). Of the eligible cardiac index operations, 85.8% (27,202/31,719) were eligible for analysis by the RACHS-1 method, and 94.0% (29,813/31,719) were eligible for analysis by the ABC approach. With both RACHS-1 and ABC, as complexity increases, discharge mortality also increases. The ABC approach allows classification of more operations, whereas the RACHS-1 discriminates better at the higher end of complexity. Complexity stratification is a useful method for analyzing the impact of case mix on pediatric cardiac surgical outcomes. Both the RACHS-1 and ABC methods facilitate complexity stratification in the STS database.
AB - Quality-of-care evaluation must take into account variations in "case mix." This study reviewed the application of two case-mix complexity-adjustment tools in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database: the Aristotle Basic Complexity (ABC) score and the Risk Adjustment in Congenital Heart Surgery (RACHS-1) method. The 2006 STS Congenital Heart Surgery Database Report, the first STS report to incorporate both methods, included 45,635 operations from 47 centers. Each operation was assigned an ABC score in a range from 1.5 (lowest complexity) to 15 (highest complexity), an ABC level in a range from 1 (lowest complexity) to 4 (highest complexity), and a RACHS-1 category in a range from 1 (lowest risk) to 6 (highest risk). The overall discharge mortality was 3.9% (1,222/31,719 eligible cardiac index operations). Of the eligible cardiac index operations, 85.8% (27,202/31,719) were eligible for analysis by the RACHS-1 method, and 94.0% (29,813/31,719) were eligible for analysis by the ABC approach. With both RACHS-1 and ABC, as complexity increases, discharge mortality also increases. The ABC approach allows classification of more operations, whereas the RACHS-1 discriminates better at the higher end of complexity. Complexity stratification is a useful method for analyzing the impact of case mix on pediatric cardiac surgical outcomes. Both the RACHS-1 and ABC methods facilitate complexity stratification in the STS database.
KW - Congenital heart disease
KW - Database
KW - Patient safety
KW - Pediatric heart surgery
KW - Registry
KW - Surgical outcomes
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U2 - 10.1007/s00246-009-9496-0
DO - 10.1007/s00246-009-9496-0
M3 - Article
C2 - 19771463
AN - SCOPUS:76549124866
SN - 0172-0643
VL - 30
SP - 1117
EP - 1130
JO - Pediatric Cardiology
JF - Pediatric Cardiology
IS - 8
ER -