title: 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.
abstract: Quality-of-care evaluation must take into account variations in "ase 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 ncreases. 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.
authors.affiliation: The Congenital Heart Institute of Florida, Division of Thoracic and Cardiovascular Surgery, All Children' Hospital and Children's Hospital of Tampa, University of South Florida College of Medicine, Cardiac Surgical Associates of Florida (CSAoF), Saint Petersburg, FL 33701, USA. JeffJacobs@msn.com
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.forename: Marshall L
authors.initials: ML
authors.lastname: Jacobs
authors.forename: Francois G
authors.initials: FG
authors.lastname: Lacour-Gayet
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Jenkins
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.forename: Emile
authors.initials: E
authors.lastname: Bacha
authors.forename: Bohdan
authors.initials: B
authors.lastname: Maruszewski
authors.forename: David R
authors.initials: DR
authors.lastname: Clarke
authors.forename: Christo I
authors.initials: CI
authors.lastname: Tchervenkov
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Spray
authors.forename: Giovanni
authors.initials: G
authors.lastname: Stellin
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Bien
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Elliott
authors.forename: Constantine
authors.initials: C
authors.lastname: Mavroudis
mesh_terms: D000293:Adolescent; D000465:Algorithms; D013504:Cardiovascular Surgical Procedures / Q000145:classification / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual / Q000706:statistics & numerical data*; D003953:Diagnosis-Related Groups; D005260:Female; D006305:Health Status Indicators; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D020379:Risk Adjustment / Q000379:methods*; D012449:Safety / Q000706:statistics & numerical data; D019616:Thoracic Surgical Procedures / Q000295:instrumentation / Q000706:statistics & numerical data; D014481:United States