title: The importance of patient-specific preoperative factors: an analysis of the society of thoracic surgeons congenital heart surgery database.
abstract: BACKGROUND
  The most common forms of risk adjustment for pediatric and congenital heart surgery used today are based mainly on the estimated risk of mortality of the primary procedure of the operation. The goals of this analysis were to assess the association of patient-specific preoperative factors with mortality and to determine which of these preoperative factors to include in future pediatric and congenital cardiac surgical risk models.
  
  
  METHODS
  All index cardiac operations in The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) during 2010 through 2012 were eligible for inclusion. Patients weighing less than 2.5 kg undergoing patent ductus arteriosus closure were excluded. Centers with more than 10% missing data and patients with missing data for discharge mortality or other key variables were excluded. Rates of discharge mortality for patients with or without specific preoperative factors were assessed across age groups and were compared using Fisher's exact test.
  
  
  RESULTS
  In all, 25,476 operations were included (overall discharge mortality 3.7%, n=943). The prevalence of common preoperative factors and their associations with discharge mortality were determined. Associations of the following preoperative factors with discharge mortality were all highly significant (p<0.0001) for neonates, infants, and children: mechanical circulatory support, renal dysfunction, shock, and mechanical ventilation.
  
  
  CONCLUSIONS
  Current STS-CHSD risk adjustment is based on estimated risk of mortality of the primary procedure of the operation as well as age, weight, and prematurity. The inclusion of additional patient-specific preoperative factors in risk models for pediatric and congenital cardiac surgery could lead to increased precision in predicting risk of operative mortality and comparison of observed to expected outcomes.
authors.affiliation: Johns Hopkins All Children's Heart Institute, Saint Petersburg, Florida; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: jeffjacobs@msn.com.
authors.forename: Jeffrey Phillip
authors.initials: JP
authors.lastname: Jacobs
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Brien
authors.affiliation: Department of Pediatrics and Communicable Diseases, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan.
authors.forename: Sara K
authors.initials: SK
authors.lastname: Pasquali
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Sunghee
authors.initials: S
authors.lastname: Kim
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.affiliation: Division of Pediatric Cardiac Surgery, Benioff Children's Hospital, University of California San Francisco, San Francisco, California.
authors.forename: Christo Ivanov
authors.initials: CI
authors.lastname: Tchervenkov
authors.affiliation: Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: Tara
authors.initials: T
authors.lastname: Karamlou
authors.affiliation: Children's Hospital of Illinois, Peoria, Illinois.
authors.forename: Karl F
authors.initials: KF
authors.lastname: Welke
authors.affiliation: Royal Brompton Hospital, London, United Kingdom.
authors.forename: Francois
authors.initials: F
authors.lastname: Lacour-Gayet
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Constantine
authors.initials: C
authors.lastname: Mavroudis
authors.affiliation: Children's Hospital Boston, Harvard University Medical School, Boston, Massachusetts.
authors.forename: John E
authors.initials: JE
authors.lastname: Mayer
authors.affiliation: Children's National Heart Institute, Children's National Medical Center, Washington, DC.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Jonas
authors.affiliation: Shands Jacksonville, University of Florida, College of Medicine-Jacksonville, Jacksonville, Florida.
authors.forename: Fred H
authors.initials: FH
authors.lastname: Edwards
authors.affiliation: University of Colorado Denver, School of Medicine, Aurora, Colorado.
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Grover
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: David M
authors.initials: DM
authors.lastname: Shahian
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Marshall Lewis
authors.initials: ML
authors.lastname: Jacobs
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012955:Societies, Medical; D015996:Survival Rate / Q000639:trends; D019616:Thoracic Surgical Procedures; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology