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.

Published on Sep 23, 2009in Pediatric Cardiology1.655
· DOI :10.1007/S00246-009-9496-0
Emile A. Bacha65
Estimated H-index: 65
(Boston Children's Hospital)
Sources
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.
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References24
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#1Marshall L. Jacobs (Drexel University)H-Index: 74
#2Jeffrey P. Jacobs (USF: University of South Florida)H-Index: 91
Last. François Lacour-Gayet (University of Colorado Denver)H-Index: 61
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Meaningful evaluation of quality of care must account for variations in the population of patients receiving treatment, or “case-mix”. In adult cardiac surgery, empirical clinical data, initially from tens of thousands, and more recently hundreds of thousands of operations, have been used to develop risk-models, to increase the accuracy with which the outcome of a given procedure on a given patient can be predicted, and to compare outcomes on non-identical patient groups between centres, surgeon...
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#3Emile A. Bacha (Boston Children's Hospital)H-Index: 65
A large body of literature devoted to “patient safety” and error prevention exists and utilizes a nomenclature that can be applied specifically to the field of congenital cardiac disease and aid in the goals of increasing the safety of patients, decreasing medical error, minimizing mortality and morbidity, and evaluating quality of care. The purpose of this manuscript is to suggest and document a quality of health care taxonomy and the appropriate application of this nomenclature of “patient saf...
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#6Christo I. Tchervenkov (McGill University)H-Index: 13
#7Rodney Franklin (Imperial College London)H-Index: 12
This review discusses the historical aspects, current state of the art, and potential future advances in the areas of nomenclature and databases for the analysis Of Outcomes of treatments for patients with congenitally malformed hearts. We will consider the current state of analysis of outcomes, lay out some principles which might make it possible to achieve life-long monitoring and follow-up using our databases, and describe the next steps those involved in the care of these patients need to ta...
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#1David R. Clarke (University of Colorado Denver)H-Index: 34
#2François Lacour-Gayet (University of Colorado Denver)H-Index: 61
Last. Constantine Mavroudis (NU: Northwestern University)H-Index: 84
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When designed in 2000, the Aristotle Complexity Score was entirely based on subjective probability. This approach, based on the opinion of experts, was considered a good solution due to the limited amount of data available. In 2008, the next generation of the complexity score will be based on observed data available from over 100,000 congenital cardiac operations currently gathered in the congenital cardiac surgery databases of the Society of Thoracic Surgeons and the European Association for Ca...
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#1Sean M. O'Brien (Duke University)H-Index: 88
#2Jeffrey P. Jacobs (USF: University of South Florida)H-Index: 91
Last. François Lacour-Gayet (Boston Children's Hospital)H-Index: 61
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Background The Aristotle Basic Complexity Score (ABC score) was derived by consensus of an international surgeon panel to facilitate assessment of surgical performance for quality improvement in congenital heart surgery. The utility of the ABC score depends on its ability to correctly classify procedures according to their potential for morbidity, mortality, and technical difficulty. This collaborative study combined two multiinstitution databases to assess how well the ABC score predicts the ac...
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#8Thomas Yeh (UTSW: University of Texas Southwestern Medical Center)H-Index: 22
effrey P. Jacobs, MD, Marshall L. Jacobs, MD, Constantine Mavroudis, MD, ohdan Maruszewski, MD, PhD, Christo I. Tchervenkov, MD, rancois G. Lacour-Gayet, MD, David R. Clarke, MD, Thomas Yeh, Jr, MD, enry L. Walters III, MD, Hiromi Kurosawa, MD, Giovanni Stellin, MD, jark Ebels, MD, PhD, Martin J. Elliott, MBBS, MD, David F. Vener, MD, aul Barach, MD, MPH, Oscar J. Benavidez, MD, MPP, and Emile A. Bacha, MD
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This review discusses the historical aspects, current state of the art, and potential future advances in the areas of nomenclature and databases for congenital heart disease. Five areas will be reviewed: (1) common language = nomenclature, (2) mechanism of data collection (database or registry) with an established uniform core data set, (3) mechanism of evaluating case complexity, (4) mechanism to ensure and verify data completeness and accuracy, and (5) collaboration between medical subspecialt...
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#1Osman O. Al-Radi (U of T: University of Toronto)H-Index: 18
#2Frank E. Harrell (Vandy: Vanderbilt University)H-Index: 110
Last. William G. Williams (U of T: University of Toronto)H-Index: 101
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Objective The Aristotle Basic Complexity score and the Risk Adjustment in Congenital Heart Surgery system were developed by consensus to compare outcomes of congenital cardiac surgery. We compared the predictive value of the 2 systems. Methods Of all index congenital cardiac operations at our institution from 1982 to 2004 (n = 13,675), we were able to assign an Aristotle Basic Complexity score, a Risk Adjustment in Congenital Heart Surgery score, and both scores to 13,138 (96%), 11,533 (84%), an...
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#1Marshall L. Jacobs (Drexel University)H-Index: 74
#2Constantine Mavroudis (Children's Memorial Hospital)H-Index: 84
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Background Limited information is available concerning the congenital heart surgery workforce in North America. To obtain reliable data, The Society of Thoracic Surgeons (STS) Workforce on Congenital Heart Surgery undertook a subspecialty focused survey. Methods Preliminary research of websites and databases revealed a potential target group of 263 congenital heart surgeons, including 248 surgeons at 121 US centers and 15 at eight Canadian sites. Surveys were sent to these, plus any additional i...
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#1Karl F. Welke (OHSU: Oregon Health & Science University)H-Index: 38
#2Irving Shen (OHSU: Oregon Health & Science University)H-Index: 18
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Background The purpose of this study is to evaluate whether published and widely quoted mortality rates for pediatric cardiac surgery accurately reflect current expectations. Our hypotheses are that (1) mortality rates at high-quality pediatric cardiac programs are lower than published national results despite (2) a change in case mix with a shift away from low complexity operations. Methods We requested data for all pediatric cardiac surgical procedures performed between 2001 and 2004 at 29 Con...
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