[Neonatal cardiac surgery: assessment and comparison of surgical results using the RACHS-1 risk adjustment method].
BACKGROUND
The RACHS-1 method (Risk Adjustment for Congenital Heart Surgery) is widely used to predict mortality and risk adjustment in pediatric cardiovascular surgery and constitutes a valid tool to compare results among different health centers.


OBJECTIVE
To analyze if the mortality observed in the neonatal group is related to age and/or the risk stratification according to RACHS-1.


METHODS
From March 2001 to May 2008 we operated on 751 consecutive patients: 160 neonates (0-30 days), 309 infants (31 days-1 year) and 282 olders (1-18 years). Patients in each group were analyzed according to age, RACHS-1, and mortality. We used a logistic regression in which the mortality was the dependent variable and the age and RACHS-1 the independent variables.


RESULTS
The total crude mortality was 4.3%, the neonatal 9.2%. We observed a significant statistical difference of RACHS-1 distribution according to age (chi(2)= 219, p< 0.0001). Logistic analysis showed no statistical difference of mortality (p> 0.05) in the age groups compared to RACHS-1. Furthermore, RACHS-1 is a most powerful mortality predictor (p< 0.001) while age is not (p= 0.8). Using our unit one of RACHS-1 as control group, the odds ratio of the different ages were 2.1 (CI 95%: 1.6-2.7) for each RACHS group.


CONCLUSIONS
The age of surgery was not an independent risk factor as to mortality. The RACHS-1 method appeared as a powerful risk factor predictor of mortality; no differences were found in the age groups when classified by RACHS -1.
Ithuralde
Mariano
M
Departamento de Cardiología Infantil y de Cirugía Cardiovascular Pediátrica, FLENI, Ciudad Autónoma de Buenos Aires. drithuralde@fibertel.com.ar
Ballestrini
María
M
Ithuralde
Alejandro
A
Seara
Carlos
C
García Nani
María A
MA
Campos
Marcelo
M
Fernández
Nelly
N
García Delucis
Pablo
P
Nojek
Carlos
C
D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment