title: The Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model: Part 2-Clinical Application.
abstract: BACKGROUND
  The empirically derived 2014 Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model incorporates adjustment for procedure type and patient-specific factors. The purpose of this report is to describe this model and its application in the assessment of variation in outcomes across centers.
  
  
  METHODS
  All index cardiac operations in The Society of Thoracic Surgeons Congenital Heart Surgery Database (January 1, 2010, to December 31, 2013) were eligible for inclusion. Isolated patent ductus arteriosus closures in patients weighing less than or equal to 2.5 kg were excluded, as were centers with more than 10% missing data and patients with missing data for key variables. The model includes the following covariates: primary procedure, age, any prior cardiovascular operation, any noncardiac abnormality, any chromosomal abnormality or syndrome, important preoperative factors (mechanical circulatory support, shock persisting at time of operation, mechanical ventilation, renal failure requiring dialysis or renal dysfunction (or both), and neurological deficit), any other preoperative factor, prematurity (neonates and infants), and weight (neonates and infants). Variation across centers was assessed. Centers for which the 95% confidence interval for the observed-to-expected mortality ratio does not include unity are identified as lower-performing or higher-performing programs with respect to operative mortality.
  
  
  RESULTS
  Included were 52,224 operations from 86 centers. Overall discharge mortality was 3.7% (1,931 of 52,224). Discharge mortality by age category was neonates, 10.1% (1,129 of 11,144); infants, 3.0% (564 of 18,554), children, 0.9% (167 of 18,407), and adults, 1.7% (71 of 4,119). For all patients, 12 of 86 centers (14%) were lower-performing programs, 67 (78%) were not outliers, and 7 (8%) were higher-performing programs.
  
  
  CONCLUSIONS
  The 2014 Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model facilitates description of outcomes (mortality) adjusted for procedural and for patient-level factors. Identification of low-performing and high-performing programs may be useful in facilitating quality improvement efforts.
authors.affiliation: Johns Hopkins All Children's Heart Institute, Saint Petersburg, Tampa, and Orlando, Florida; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Florida Hospital for Children, Orlando, Florida. Electronic address: jeffjacobs@msn.com.
authors.forename: Jeffrey P
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: Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: John E
authors.initials: JE
authors.lastname: Mayer
authors.affiliation: Division of Pediatric Cardiac Surgery, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California.
authors.forename: Tara
authors.initials: T
authors.lastname: Karamlou
authors.affiliation: Section of Congenital Cardiovascular Surgery, University of Illinois College of Medicine at Peoria, Children's Hospital of Illinois, Peoria, Illinois.
authors.forename: Karl F
authors.initials: KF
authors.lastname: Welke
authors.affiliation: Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Filardo
authors.affiliation: The Society of Thoracic Surgeons, Chicago, Illinois.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Han
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: Johns Hopkins All Children's Heart Institute, Saint Petersburg, Tampa, and Orlando, Florida; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Florida Hospital for Children, Orlando, Florida.
authors.forename: James A
authors.initials: JA
authors.lastname: Quintessenza
authors.affiliation: Nemours/Alfred I. duPont Hospital, Wilmington, Delaware.
authors.forename: Christian
authors.initials: C
authors.lastname: Pizarro
authors.affiliation: McGill University, Montreal Children's Hospital, Montreal, Ontario, Canada.
authors.forename: Christo I
authors.initials: CI
authors.lastname: Tchervenkov
authors.affiliation: Royal Brompton Hospital, London, United Kingdom.
authors.forename: Francois
authors.initials: F
authors.lastname: Lacour-Gayet
authors.affiliation: Johns Hopkins All Children's Heart Institute, Saint Petersburg, Tampa, and Orlando, Florida; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Florida Hospital for Children, Orlando, Florida.
authors.forename: Constantine
authors.initials: C
authors.lastname: Mavroudis
authors.affiliation: Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
authors.forename: Carl L
authors.initials: CL
authors.lastname: Backer
authors.affiliation: Kosair Children's Hospital, University of Louisville, Louisville, Kentucky.
authors.forename: Erle H
authors.initials: EH
authors.lastname: Austin
authors.affiliation: Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Fraser
authors.affiliation: Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
authors.forename: James S
authors.initials: JS
authors.lastname: Tweddell
authors.affiliation: Children's National Medical Center, Washington D.C.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Jonas
authors.affiliation: 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: University of Michigan, Ann Arbor, Michigan.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Prager
authors.affiliation: Massachusetts General Hospital Department of Surgery and Center for Quality and Safety, and Harvard Medical School, Boston, Massachusetts.
authors.forename: David M
authors.initials: DM
authors.lastname: Shahian
authors.affiliation: Johns Hopkins All Children's Heart Institute, Saint Petersburg, Tampa, and Orlando, Florida; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Florida Hospital for Children, Orlando, Florida.
authors.forename: Marshall L
authors.initials: ML
authors.lastname: Jacobs
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015233:Models, Statistical; D018570:Risk Assessment; D012955:Societies, Medical; D013903:Thoracic Surgery; D019616:Thoracic Surgical Procedures; D055815:Young Adult