title: The Aristotle score predicts mortality after surgery of patent ductus arteriosus in preterm infants.
abstract: BACKGROUND
  Outcomes after surgical ligation of patent ductus arteriosus (PDA) in preterm infants are often complicated by prematurity associated comorbidities. The Aristotle comprehensive complexity score (ACCS) has been proposed as a useful tool for complexity adjustment in the analysis of outcome after congenital heart surgery. The aims of this study were to define preoperative risk factors for mortality and to demonstrate the usefulness of ACCS to predict mortality after surgical ligation of PDA in the preterm.
  
  
  METHODS
  Included were 49 preterm babies (≤35 weeks of gestation) who had surgical ligation of PDA between May 2009 and July 2012. Median gestational age was 27.6 weeks (range, 23 to 35 weeks) and median birth weight was 1,040 g (range, 520 to 2,280 g). Median age at operation was 15 days (range, 4 to 44 days) and median weight was 1,120 g (range, 400 to 2,880 g). Initial oral ibuprofen was ineffective in 24 patients and contraindicated in 25. All surgical ligations were done at bedside in the neonatal intensive care unit. Preoperative clinical and laboratory profiles were reviewed and ACCS was derived.
  
  
  RESULTS
  Eight of 49 patients (16.3%) died at a median of 14 days (range, 2 to 73 days) after PDA ligation. Patients who had contraindications for oral ibuprofen (odds ratio [OR] 8.94; p=0.049), coagulopathy (OR 12.13; p=0.025), renal dysfunction (OR 28.88; p=0.003), intraventricular hemorrhage greater than grade II or seizure (OR 34.00; p=0.002), and ACCS points (OR 29.594; p<0.05) were significantly associated with an increased risk for mortality. Among the risk factors, ACCS showed the largest area under curve (0.991) by receiver-operating characteristic curve analysis. Optimal cutoff value of ACCS for mortality were 15 or greater, with sensitivity of 87.5%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 97.6%.
  
  
  CONCLUSIONS
  The ACCS, especially for procedure-independent complexity factors, is a useful tool to predict mortality after ligation of PDA in preterm infants.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Yun Hee
authors.initials: YH
authors.lastname: Chang
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Jeong Eun
authors.initials: JE
authors.lastname: Kim
authors.forename: Ji-yong
authors.initials: JY
authors.lastname: Kim
authors.forename: YoungAh
authors.initials: Y
authors.lastname: Youn
authors.forename: Eun-Jung
authors.initials: EJ
authors.lastname: Lee
authors.forename: Sena
authors.initials: S
authors.lastname: Moon
authors.forename: Ju Young
authors.initials: JY
authors.lastname: Lee
authors.forename: In Kyung
authors.initials: IK
authors.lastname: Sung
mesh_terms: D000704:Analysis of Variance; D006348:Cardiac Surgical Procedures / Q000401:mortality* / Q000592:standards*; D002423:Cause of Death; D015331:Cohort Studies; D004374:Ductus Arteriosus, Patent / Q000145:classification* / Q000401:mortality / Q000601:surgery*; D004502:Education, Medical, Continuing; D005260:Female; D005865:Gestational Age; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008026:Ligation / Q000379:methods; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
keywords: 20