title: An empirically based tool for analyzing morbidity associated with operations for congenital heart disease.
abstract: OBJECTIVE
  Congenital heart surgery outcomes analysis requires reliable methods of estimating the risk of adverse outcomes. Contemporary methods focus primarily on mortality or rely on expert opinion to estimate morbidity associated with different procedures. We created an objective, empirically based index that reflects statistically estimated risk of morbidity by procedure.
  
  
  METHODS
  Morbidity risk was estimated using data from 62,851 operations in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2002-2008). Model-based estimates with 95% Bayesian credible intervals were calculated for each procedure's average risk of major complications and average postoperative length of stay. These 2 measures were combined into a composite morbidity score. A total of 140 procedures were assigned scores ranging from 0.1 to 5.0 and sorted into 5 relatively homogeneous categories.
  
  
  RESULTS
  Model-estimated risk of major complications ranged from 1.0% for simple procedures to 38.2% for truncus arteriosus with interrupted aortic arch repair. Procedure-specific estimates of average postoperative length of stay ranged from 2.9 days for simple procedures to 42.6 days for a combined atrial switch and Rastelli operation. Spearman rank correlation between raw rates of major complication and average postoperative length of stay was 0.82 in procedures with n greater than 200. Rate of major complications ranged from 3.2% in category 1 to 30.0% in category 5. Aggregate average postoperative length of stay ranged from 6.3 days in category 1 to 34.0 days in category 5.
  
  
  CONCLUSIONS
  Complication rates and postoperative length of stay provide related but not redundant information about morbidity. The Morbidity Scores and Categories provide an objective assessment of risk associated with operations for congenital heart disease, which should facilitate comparison of outcomes across cohorts with differing case mixes.
authors: Department of Pediatric and Congenital Heart Surgery, Cleveland Clinic, Cleveland, Ohio. Electronic address: marshall.jacobs@comcast.net.
authors: Marshall L
authors: ML
authors: Jacobs
authors: Department of Biostatistics, Duke University School of Medicine and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors: Sean M
authors: SM
authors: O'Brien
authors: The Congenital Heart Institute of Florida, All Children's Hospital and Children's Hospital of Tampa, Cardiac Surgical Associates of Florida, University of South Florida College of Medicine, St Petersburg and Tampa, Fla.
authors: Jeffrey P
authors: JP
authors: Jacobs
authors: Congenital Heart Institute, Florida Hospital for Children, Orlando, Fla.
authors: Constantine
authors: C
authors: Mavroudis
authors: Pediatric Cardiac Surgery Department, Montefiore Children's Hospital, Montefiore Medical Center, New York, NY.
authors: Francois
authors: F
authors: Lacour-Gayet
authors: Department of Pediatrics, Duke University School of Medicine and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors: Sara K
authors: SK
authors: Pasquali
authors: Cardiothoracic Surgery, Seattle Children's Hospital, Seattle, Wash.
authors: Karl
authors: K
authors: Welke
authors: Nemours Cardiac Center, Wilmington, Del.
authors: Christian
authors: C
authors: Pizarro
authors: Cardiac Surgery, Children's Hospital of the King's Daughters, Norfolk, Va.
authors: Felix
authors: F
authors: Tsai
authors: Department of Cardiothoracic Surgery, The Children's Hospital, Aurora, Colo.
authors: David R
authors: DR
authors: Clarke
mesh_terms: D006331:Heart Diseases / Q000151:congenital* / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*; D018570:Risk Assessment / Q000379:methods*