 |
|
| Case-mix Complexity Adjustment using both RACHS-1 and Aristotle applied to 45635 Operations in the STS Congenital Database |
|
Jeffrey P. Jacobs1, Marshall L. Jacobs2, Francois G. Lacour-Gayet3, Kathy Jenkins4, Kimberlee Gauvreau4, Emile Bacha4, Bohdan Maruszewski5, David R. Clarke3, Christo I. Tchervenkov6, J. Wiliam Gaynor7, Thomas L. Spray7, Giovanni Stellin8, Martin J. Elliott9, Constantine Mavroudis10; 1The Congenital Heart Institute of Florida (CHIF), University of South Florida (USF), Saint Petersburg and Tampa, FL; 2St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA; 3Denver Children's Hospital, University of Colorado School of Medicine, Denver, CO; 4Boston Children's Hospital, Harvard University, Boston, MA; 5Children's Memorial Health Institute, Warsaw, Poland; 6Montreal Children's Hospital, McGill University, Montreal, QC, Canada; 7The Cardiac Center at The Children's Hospital of Philadelphia, Philadelphia, PA; 8University of Padova Medical School, Padova, Italy; 9Great Ormond Street Hospital for Children, London, United Kingdom; 10Childrens Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL Objective: Case-mix complexity adjustment represents an integral component of congenital heart surgery multi-institutional outcomes analysis. Two consensus-based tools exist to facilitate this effort: the Aristotle Basic Complexity Score (ABCS) and the Risk Adjustment in Congenital Heart Surgery (RACHS-1) method. We review the application of these complexity adjustment techniques in the 2006 STS Congenital Database Report, which is the first STS database report to incorporate both systems. Methods: The 2006 STS Congenital Database Report included 45635 submitted operations from 47 North American Congenital Heart Surgery Centers. The ABCS is based on the Primary Procedure of a given operation as defined by the Short List of procedures of the EACTS-STS International Nomenclature. The ABCS defines complexity through 3 factors: Mortality Potential, Morbidity Potential, and Technical Difficulty. Each procedure in the Short List of procedures of the EACTS-STS International Nomenclature is assigned an ABCS of 1.5 through 15 (1.5 representing the lowest complexity and 15 representing the highest) and an ABCS Level of 1 to 4 (1 representing the lowest complexity and 4 representing the highest). The RACHS-1 system places surgical procedures into six risk categories based on expected discharge mortality (1 representing the lowest risk and 6 representing the highest). Functionally, the RACHS-1 system has five levels because there are too few cases in category 5 to estimate mortality rates. Results: Overall discharge mortality was 3.9 % (1222/31719 eligible cardiac index operations). 85.8% (27202/31719) of operations were eligible for analysis by the RACHS-1 system and 94.0% (29813/31719) were eligible for analysis by the ABCS. Table 1 documents mortality by complexity level. Conclusion: With both RACHS-1 and Aristotle, as complexity increases, discharge mortality also increases. Equipoise exists to justify ongoing research in 2 areas: 1. Unification of these two methods of complexity adjustment to capitalize on the advantages of each system. 2. Standardization of morbidity measurements to facilitate evaluation of quality of care for all patients, as analysis of operative mortality focuses on only 4% of the total surgical patient population.
Back to Annual Meeting Back to Program Outline |
We Model Excellence |
|
Read the Privacy Policy.
IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.