Initial application in the STS congenital database of complexity adjustment to evaluate surgical case mix and results.
BACKGROUND
The analysis of the second harvest (1998-2001) of the Society of Thoracic Surgeons Congenital Heart Surgery Database included the first attempt by the STS to apply a complexity-adjustment method to evaluate congenital heart surgery results.


METHODS
This data harvest represents the first STS multiinstitutional experience with software utilizing the international nomenclature and database specifications adopted by the STS and the European Association for Cardio-Thoracic Surgery (April 2000 Annals of Thoracic Surgery) and the first STS Congenital Database Report incorporating a methodology facilitating complexity adjustment. This methodology, allowing for complexity adjustment, gives each operation a basic complexity score (1.5 to 15) and level (1 to 4) based upon the work of the EACTS-STS Aristotle Committee, a panel of 50 expert surgeons. The complexity scoring, based on the primary procedure (from the EACTS-STS International Nomenclature Procedures Short List), estimates complexity through three factors: mortality potential, morbidity potential, and technical difficulty.


RESULTS
This STS harvest includes data from 16 centers reporting 12,787 cases, with discharge mortality known for 10,246 cases. The basic complexity score has been applied to the outcomes analysis of these cases and a new equation has been proposed to evaluate one aspect of performance: Aristotle Performance Index = Outcome x Complexity = (Survival) x (Mean Complexity Score)


CONCLUSIONS
The complexity analysis represents a basic complexity-adjustment method to evaluate surgical results. Complexity is a constant precise value for a given patient at a given point in time; performance varies between centers. Future STS congenital data harvests will incorporate a second step, the Comprehensive Aristotle Score, utilizing additional patient specific complexity modifiers to allow a more precise complexity adjustment.
Jacobs
Jeffrey Phillip
JP
The Congenital Heart Institute of Florida (CHIF), All Children's Hospital, Children's Hospital of Tampa, University of South Florida, St. Petersburg, Florida FL33701, USA. jeffjacobs@msn.com
Lacour-Gayet
Francois G
FG
Jacobs
Marshall Lewis
ML
Clarke
David Robinson
DR
Tchervenkov
Christo I
CI
Gaynor
J William
JW
Spray
Thomas L
TL
Maruszewski
Bohdan
B
Stellin
Giovanni
G
Gould
Jay
J
Dokholyan
Rachel S
RS
Peterson
Eric D
ED
Elliott
Martin J
MJ
Mavroudis
Constantine
C
D016208:Databases, Factual; D003953:Diagnosis-Related Groups; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D012984:Software; D016019:Survival Analysis; D019616:Thoracic Surgical Procedures / Q000401:mortality; D016896:Treatment Outcome; D014481:United States