title: Impact of Surgical Complexity on Health-Related Quality of Life in Congenital Heart Disease Surgical Survivors.
abstract: Surgical complexity and related morbidities may affect long-term patient quality of life (QOL). Aristotle Basic Complexity (ABC) score and Risk Adjustment in Congenital Heart Surgery (RACHS-1) category stratify the complexity of pediatric cardiac operations. The purpose of this study was to examine the relationship between surgical complexity and QOL and to investigate other demographic and clinical variables that might explain variation in QOL in pediatric cardiac surgical survivors.
  
  
  
  Pediatric Cardiac Quality of Life (PCQLI) study participants who had undergone cardiac surgery were included. The PCQLI database provided sample characteristics and QOL scores. Surgical complexity was defined by the highest ABC raw score or RACHS-1 category. Relationships among surgical complexity and demographic, clinical, and QOL variables were assessed using ordinary least squares regression. A total of 1416 patient-parent pairs were included. Although higher ABC scores and RACHS-1 categories were associated with lower QOL scores (P<0.005), correlation with QOL scores was poor to fair (r=-0.10 to -0.29) for all groups. Ordinary least squares regression showed weak association with R(2)=0.06 to R(2)=0.28. After accounting for single-ventricle anatomy, number of doctor visits, and time since last hospitalization, surgical complexity scores added no additional explanation to the variance in QOL scores.
  
  
  
  ABC scores and RACHS-1 categories are useful tools for morbidity and mortality predictions prior to cardiac surgery and quality of care initiatives but are minimally helpful in predicting a child's or adolescent's long-term QOL scores. Further studies are warranted to determine other predictors of QOL variation.
authors.affiliation: Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Amy M
authors.initials: AM
authors.lastname: O'Connor
authors.affiliation: Cardiorespiratory Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK Department of Pediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
authors.forename: Jo
authors.initials: J
authors.lastname: Wray
authors.affiliation: Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Ryan S
authors.initials: RS
authors.lastname: Tomlinson
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Amy
authors.initials: A
authors.lastname: Cassedy
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, The Congenital Heart Institute of Florida, All Children's Hospital and Children's Hospital of Tampa, University of South Florida College of Medicine, Cardiac Surgical Associates, St. Petersburg and Tampa, FL.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.affiliation: Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, MA Department of Pediatrics, Harvard Medical School, Boston, MA.
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Jenkins
authors.affiliation: Cardiorespiratory Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
authors.forename: Kate L
authors.initials: KL
authors.lastname: Brown
authors.affiliation: Department of Pediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
authors.forename: Rodney C G
authors.initials: RC
authors.lastname: Franklin
authors.affiliation: Division of Cardiology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Lynn
authors.initials: L
authors.lastname: Mahony
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Children's Hospital of Wisconsin, Milwaukee, WI.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Mussatto
authors.affiliation: Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, MA Department of Pediatrics, Harvard Medical School, Boston, MA.
authors.forename: Jane W
authors.initials: JW
authors.lastname: Newburger
authors.affiliation: Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, PA Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, PA.
authors.forename: Gil
authors.initials: G
authors.lastname: Wernovsky
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Ittenbach
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Dennis
authors.initials: D
authors.lastname: Drotar
authors.affiliation: Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH bradley.marino@northwestern.edu.
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Marino
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures; D002648:Child; D016208:Databases, Factual; D005260:Female; D006304:Health Status; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D008297:Male; D011788:Quality of Life; D017741:Survivors; D013812:Therapeutics; D006113:United Kingdom; D014481:United States
keywords: Aristotle Basic Complexity; Risk Adjustment in Congenital Heart Surgery; congenital heart disease surgery; quality of life