Stratification of complexity improves the utility and accuracy of outcomes analysis in a multi-institutional congenital heart surgery database: 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

Jeffrey P. Jacobs, Marshall L. Jacobs, Francois G. Lacour-Gayet, Kathy J. Jenkins, Kimberlee Gauvreau, Emile Bacha, Bohdan Maruszewski, David R. Clarke, Christo I. Tchervenkonv, J. William Gaynor, Thomas L. Spray, Giovanni Stellin, Sean M. O'Brien, Martin J. Elliott, Constantine Mavroudis

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1117-1130
Number of pages14
JournalPediatric Cardiology
Volume30
Issue number8
DOIs
StatePublished - Nov 2009
Externally publishedYes

Keywords

  • Congenital heart disease
  • Database
  • Patient safety
  • Pediatric heart surgery
  • Registry
  • Surgical outcomes

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

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