Rachs-1 system in risk stratification for congenital heart disease surgery outcome.
BACKGROUND
The Risk Adjustment in Congenital Heart Surgery (RACHS-1) system has been used as a benchmark to compare surgical results in developed countries. Its ability to stratify postoperative mortality risk has been validated in several developed countries, however, this has not been examined in a developing country.


OBJECTIVE
To assess the ability of the RACHS-1 system to stratify postoperative mortality risk in a developing country.


METHODS
Retrospective study over a five year period between 1st January 2002 and 31st December 2006.


METHODS
Kenyatta National Hospital, a teaching and referral hospital in Nairobi, Kenya.


METHODS
Three hundred and seventeen consecutive operations were performed on 313 patients aged between 0.25 and 204 months.


RESULTS
Operations were performed in RACHS-1 categories 1, 2, 3 and 4 with hospital mortalities of 2.5%, 16.9%, 29.4% and 50% respectively. The difference in mortality between categories 1 and 2 was significant (p-value of 0.0003), however, the difference in mortality between categories 2 and 3 and categories 3 and 4 was not significant (p-values 0.193 and 0.67 respectively).


CONCLUSIONS
The RACHS-1 system did not adequately stratify risk in a low case load setting. The use of the RACHS-1 method as a benchmark to compare surgical results of paediatric cardiac surgery services in developing countries may be limited.
Awori
M N
MN
Department of Surgery, College of Health Sciences, University of Nairobi, Nairobi, Kenya.
Ogendo
S W O
SW
D000328:Adult; D019985:Benchmarking; D003906:Developing Countries; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008297:Male; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D020379:Risk Adjustment; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome