title: Acute Risk Change for Cardiothoracic Admissions to Intensive Care (ARCTIC index): a new measure of quality in cardiac surgery.
abstract: BACKGROUND
  Quality of cardiac surgical care may vary between institutions. Mortality is low and large numbers are required to discriminate between hospitals. Measures other than mortality may provide better comparisons.
  
  
  OBJECTIVE
  To develop and assess the Acute Risk Change for Cardiothoracic Admissions to Intensive Care (ARCTIC) index, a new performance measure for cardiothoracic admissions to intensive care units (ICUs).
  
  
  METHODS
  The Australian and New Zealand Society of Cardiac and Thoracic Surgeons database and Australian and New Zealand Intensive Care Society Adult Patient Database were linked. Logistic regression was used to generate a predicted risk of death first from preoperative data using the previously validated Allprocscore and second on admission to an ICU using Acute Physiology and Chronic Health Evaluation III score. Change in risk as a percentage (ARCTIC) was calculated for each patient. The validity of ARCTIC as a marker of quality was assessed by comparison with intraoperative variables and postoperative morbidity markers.
  
  
  RESULTS
  Sixteen thousand six hundred eighty-seven patients at 21 hospitals from 2008 to 2011 were matched. An increase in ARCTIC score was associated with prolonged cardiopulmonary bypass time (P = .001), intraoperative blood product transfusion (P < .001), reoperation (P < .0001), postoperative renal failure (P < .0001), prolonged ventilation (P < .0001), and stroke (P = .001).
  
  
  CONCLUSIONS
  The ARCTIC index is associated with known markers of perioperative performance and postoperative morbidity. It may be used as an overall marker of quality for cardiac surgery. Further work is required to assess ARCTIC as a method to discriminate between cardiac surgical units.
authors.affiliation: Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. Electronic address: timcoulson@doctors.org.uk.
authors.forename: Tim G
authors.initials: TG
authors.lastname: Coulson
authors.affiliation: Australian and New Zealand Intensive Care Research Centre.
authors.forename: Michael
authors.initials: M
authors.lastname: Bailey
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Lavinia
authors.initials: L
authors.lastname: Tran
authors.affiliation: Critical Care Research Group, University of Queensland, Brisbane, Australia.
authors.forename: Daniel V
authors.initials: DV
authors.lastname: Mullany
authors.affiliation: Department of Surgery, Monash University, and Department of Cardiothoracic Surgery, Monash Health, Melbourne, Australia.
authors.forename: Julian A
authors.initials: JA
authors.lastname: Smith
authors.affiliation: Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; ANZICS Centre for Outcome and Resource Evaluation, Melbourne, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Pilcher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D001803:Blood Transfusion / Q000592:standards; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000592:standards*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000592:standards; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010343:Patient Admission / Q000592:standards*; D011237:Predictive Value of Tests; D058996:Quality Improvement / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards*; D051437:Renal Insufficiency / Q000401:mortality; D012086:Reoperation; D015203:Reproducibility of Results; D012121:Respiration, Artificial / Q000592:standards; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000401:mortality; D013997:Time Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome