Adjusting for Risk Associated With Pediatric and Congenital Cardiac Catheterization: A Report From the NCDR IMPACT Registry.
BACKGROUND
As US health care increasingly focuses on outcomes as a means for quantifying quality, there is a growing demand for risk models that can account for the variability of patients treated at different hospitals so that equitable comparisons between institutions can be made. We sought to apply aspects of prior risk-standardization methodology to begin development of a risk-standardization tool for the National Cardiovascular Data Registry (NCDR) IMPACT (Improving Pediatric and Adult Congenital Treatment) Registry.


RESULTS
Using IMPACT, we identified all patients undergoing diagnostic or interventional cardiac catheterization between January 2011 and March 2013. Multivariable hierarchical logistic regression was used to identify patient and procedural characteristics predictive of experiencing a major adverse event after cardiac catheterization. A total of 19,608 cardiac catheterizations were performed between January 2011 and March 2013. Among all cases, a major adverse event occurred in 378 of all cases (1.9%). After multivariable adjustment, 8 variables were identified as critical for risk standardization: patient age, renal insufficiency, single-ventricle physiology, procedure-type risk group, low systemic saturation, low mixed venous saturation, elevated systemic ventricular end-diastolic pressure, and elevated main pulmonary artery pressures. The model had good discrimination (C statistic, 0.70), confirmed by bootstrap validation (validation C statistic, 0.69).


CONCLUSIONS
Using prior risk-standardization efforts as a foundation, we developed and internally validated a model to predict the occurrence of a major adverse event after cardiac catheterization for congenital heart disease. Future efforts should be directed toward further refinement of the model variables within this large, multicenter data set.
From Saint Luke's Mid America Heart Institute, Kansas City, MO (N.J., K.F.K., J.A.S.); Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Cincinnati Children's Hospital Medical Center, OH (R.H.B.); The Hospital for Sick Children, Toronto, ON, Canada (L.B.); Sidra Medical & Research Center, Doha, Qatar (R.H.); Boston Children's Hospital, MA (K.J., L.B.); Children's National Health System, Washington, DC (G.R.M.); Rady Children's Hospital, San Diego, CA (J.W.M.); Johns Hopkins Children's Center, Baltimore, MD (R.R.); Children's Hospital of Philadelphia, PA (J.R.); and Sibley Heart Center-Emory Children's Center, Egelston, GA (R.V.). njayaram@cmh.edu.
Natalie
N
Jayaram
From Saint Luke's Mid America Heart Institute, Kansas City, MO (N.J., K.F.K., J.A.S.); Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Cincinnati Children's Hospital Medical Center, OH (R.H.B.); The Hospital for Sick Children, Toronto, ON, Canada (L.B.); Sidra Medical & Research Center, Doha, Qatar (R.H.); Boston Children's Hospital, MA (K.J., L.B.); Children's National Health System, Washington, DC (G.R.M.); Rady Children's Hospital, San Diego, CA (J.W.M.); Johns Hopkins Children's Center, Baltimore, MD (R.R.); Children's Hospital of Philadelphia, PA (J.R.); and Sibley Heart Center-Emory Children's Center, Egelston, GA (R.V.).
Robert H
RH
Beekman
From Saint Luke's Mid America Heart Institute, Kansas City, MO (N.J., K.F.K., J.A.S.); Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Cincinnati Children's Hospital Medical Center, OH (R.H.B.); The Hospital for Sick Children, Toronto, ON, Canada (L.B.); Sidra Medical & Research Center, Doha, Qatar (R.H.); Boston Children's Hospital, MA (K.J., L.B.); Children's National Health System, Washington, DC (G.R.M.); Rady Children's Hospital, San Diego, CA (J.W.M.); Johns Hopkins Children's Center, Baltimore, MD (R.R.); Children's Hospital of Philadelphia, PA (J.R.); and Sibley Heart Center-Emory Children's Center, Egelston, GA (R.V.).
Lee
L
Benson
From Saint Luke's Mid America Heart Institute, Kansas City, MO (N.J., K.F.K., J.A.S.); Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Cincinnati Children's Hospital Medical Center, OH (R.H.B.); The Hospital for Sick Children, Toronto, ON, Canada (L.B.); Sidra Medical & Research Center, Doha, Qatar (R.H.); Boston Children's Hospital, MA (K.J., L.B.); Children's National Health System, Washington, DC (G.R.M.); Rady Children's Hospital, San Diego, CA (J.W.M.); Johns Hopkins Children's Center, Baltimore, MD (R.R.); Children's Hospital of Philadelphia, PA (J.R.); and Sibley Heart Center-Emory Children's Center, Egelston, GA (R.V.).
Ralf
R
Holzer
From Saint Luke's Mid America Heart Institute, Kansas City, MO (N.J., K.F.K., J.A.S.); Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Cincinnati Children's Hospital Medical Center, OH (R.H.B.); The Hospital for Sick Children, Toronto, ON, Canada (L.B.); Sidra Medical & Research Center, Doha, Qatar (R.H.); Boston Children's Hospital, MA (K.J., L.B.); Children's National Health System, Washington, DC (G.R.M.); Rady Children's Hospital, San Diego, CA (J.W.M.); Johns Hopkins Children's Center, Baltimore, MD (R.R.); Children's Hospital of Philadelphia, PA (J.R.); and Sibley Heart Center-Emory Children's Center, Egelston, GA (R.V.).
Kathy
K
Jenkins
From Saint Luke's Mid America Heart Institute, Kansas City, MO (N.J., K.F.K., J.A.S.); Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Cincinnati Children's Hospital Medical Center, OH (R.H.B.); The Hospital for Sick Children, Toronto, ON, Canada (L.B.); Sidra Medical & Research Center, Doha, Qatar (R.H.); Boston Children's Hospital, MA (K.J., L.B.); Children's National Health System, Washington, DC (G.R.M.); Rady Children's Hospital, San Diego, CA (J.W.M.); Johns Hopkins Children's Center, Baltimore, MD (R.R.); Children's Hospital of Philadelphia, PA (J.R.); and Sibley Heart Center-Emory Children's Center, Egelston, GA (R.V.).
Kevin F
KF
Kennedy
From Saint Luke's Mid America Heart Institute, Kansas City, MO (N.J., K.F.K., J.A.S.); Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Cincinnati Children's Hospital Medical Center, OH (R.H.B.); The Hospital for Sick Children, Toronto, ON, Canada (L.B.); Sidra Medical & Research Center, Doha, Qatar (R.H.); Boston Children's Hospital, MA (K.J., L.B.); Children's National Health System, Washington, DC (G.R.M.); Rady Children's Hospital, San Diego, CA (J.W.M.); Johns Hopkins Children's Center, Baltimore, MD (R.R.); Children's Hospital of Philadelphia, PA (J.R.); and Sibley Heart Center-Emory Children's Center, Egelston, GA (R.V.).
Gerard R
GR
Martin
From Saint Luke's Mid America Heart Institute, Kansas City, MO (N.J., K.F.K., J.A.S.); Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Cincinnati Children's Hospital Medical Center, OH (R.H.B.); The Hospital for Sick Children, Toronto, ON, Canada (L.B.); Sidra Medical & Research Center, Doha, Qatar (R.H.); Boston Children's Hospital, MA (K.J., L.B.); Children's National Health System, Washington, DC (G.R.M.); Rady Children's Hospital, San Diego, CA (J.W.M.); Johns Hopkins Children's Center, Baltimore, MD (R.R.); Children's Hospital of Philadelphia, PA (J.R.); and Sibley Heart Center-Emory Children's Center, Egelston, GA (R.V.).
John W
JW
Moore
From Saint Luke's Mid America Heart Institute, Kansas City, MO (N.J., K.F.K., J.A.S.); Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Cincinnati Children's Hospital Medical Center, OH (R.H.B.); The Hospital for Sick Children, Toronto, ON, Canada (L.B.); Sidra Medical & Research Center, Doha, Qatar (R.H.); Boston Children's Hospital, MA (K.J., L.B.); Children's National Health System, Washington, DC (G.R.M.); Rady Children's Hospital, San Diego, CA (J.W.M.); Johns Hopkins Children's Center, Baltimore, MD (R.R.); Children's Hospital of Philadelphia, PA (J.R.); and Sibley Heart Center-Emory Children's Center, Egelston, GA (R.V.).
Richard
R
Ringel
From Saint Luke's Mid America Heart Institute, Kansas City, MO (N.J., K.F.K., J.A.S.); Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Cincinnati Children's Hospital Medical Center, OH (R.H.B.); The Hospital for Sick Children, Toronto, ON, Canada (L.B.); Sidra Medical & Research Center, Doha, Qatar (R.H.); Boston Children's Hospital, MA (K.J., L.B.); Children's National Health System, Washington, DC (G.R.M.); Rady Children's Hospital, San Diego, CA (J.W.M.); Johns Hopkins Children's Center, Baltimore, MD (R.R.); Children's Hospital of Philadelphia, PA (J.R.); and Sibley Heart Center-Emory Children's Center, Egelston, GA (R.V.).
Jonathan
J
Rome
From Saint Luke's Mid America Heart Institute, Kansas City, MO (N.J., K.F.K., J.A.S.); Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Cincinnati Children's Hospital Medical Center, OH (R.H.B.); The Hospital for Sick Children, Toronto, ON, Canada (L.B.); Sidra Medical & Research Center, Doha, Qatar (R.H.); Boston Children's Hospital, MA (K.J., L.B.); Children's National Health System, Washington, DC (G.R.M.); Rady Children's Hospital, San Diego, CA (J.W.M.); Johns Hopkins Children's Center, Baltimore, MD (R.R.); Children's Hospital of Philadelphia, PA (J.R.); and Sibley Heart Center-Emory Children's Center, Egelston, GA (R.V.).
John A
JA
Spertus
From Saint Luke's Mid America Heart Institute, Kansas City, MO (N.J., K.F.K., J.A.S.); Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Cincinnati Children's Hospital Medical Center, OH (R.H.B.); The Hospital for Sick Children, Toronto, ON, Canada (L.B.); Sidra Medical & Research Center, Doha, Qatar (R.H.); Boston Children's Hospital, MA (K.J., L.B.); Children's National Health System, Washington, DC (G.R.M.); Rady Children's Hospital, San Diego, CA (J.W.M.); Johns Hopkins Children's Center, Baltimore, MD (R.R.); Children's Hospital of Philadelphia, PA (J.R.); and Sibley Heart Center-Emory Children's Center, Egelston, GA (R.V.).
Robert
R
Vincent
From Saint Luke's Mid America Heart Institute, Kansas City, MO (N.J., K.F.K., J.A.S.); Children's Mercy Hospitals and Clinics, Kansas City, MO (N.J.); Cincinnati Children's Hospital Medical Center, OH (R.H.B.); The Hospital for Sick Children, Toronto, ON, Canada (L.B.); Sidra Medical & Research Center, Doha, Qatar (R.H.); Boston Children's Hospital, MA (K.J., L.B.); Children's National Health System, Washington, DC (G.R.M.); Rady Children's Hospital, San Diego, CA (J.W.M.); Johns Hopkins Children's Center, Baltimore, MD (R.R.); Children's Hospital of Philadelphia, PA (J.R.); and Sibley Heart Center-Emory Children's Center, Egelston, GA (R.V.).
Lisa
L
Bergersen
D000293:Adolescent; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000592:standards; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010372:Pediatrics / Q000592:standards*; D012042:Registries / Q000592:standards*; D058028:Research Report / Q000592:standards*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
catheterization; heart defects, congenital; risk factors