Stratification of Complexity Improves the Utility and Accuracy of Outcomes Analysis in a Multi-Institutional Congenital Heart Surgery Database: Application of the Risk Adjustment in Congenital Heart Surgery (RACHS-1) and Aristotle Systems in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database

被引：0
作者：
Jeffrey P. Jacobs
Marshall L. Jacobs
Francois G. Lacour-Gayet
Kathy J. Jenkins
Kimberlee Gauvreau
Emile Bacha
Bohdan Maruszewski
David R. Clarke
Christo I. Tchervenkov
J. William Gaynor
Thomas L. Spray
Giovanni Stellin
Sean M. O’Brien
Martin J. Elliott
Constantine Mavroudis
机构：
[1] All Children’s Hospital and Children’s Hospital of Tampa,The Congenital Heart Institute of Florida (CHIF), Division of Thoracic and Cardiovascular Surgery
[2] University of South Florida College of Medicine,Boston Children’s Hospital
[3] Cardiac Surgical Associates of Florida (CSAoF),Montreal Children’s Hospital
[4] The Cleveland Clinic Children’s Hospital,undefined
[5] Center for Pediatric and Adult Congenital Heart Diseases,undefined
[6] Children’s Hospital at Montefiore,undefined
[7] Harvard University,undefined
[8] Children’s Memorial Health Institute,undefined
[9] The Children’s Hospital,undefined
[10] University of Colorado Denver School of Medicine,undefined
[11] McGill University,undefined
[12] The Cardiac Center at The Children’s Hospital of Philadelphia,undefined
[13] University of Padova Medical School,undefined
[14] Duke University Medical Center,undefined
[15] Great Ormond Street Hospital for Children,undefined
来源：
Pediatric Cardiology | 2009年 / 30卷
关键词：
Congenital heart disease; Database; Patient safety; Pediatric heart surgery; Registry; Surgical outcomes;
D O I：
暂无
中图分类号：
学科分类号：
摘要：
Quality-of-care evaluation must take into account variations in “case mix.” This study reviewed the application of two case-mix complexity-adjustment tools in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database: the Aristotle Basic Complexity (ABC) score and the Risk Adjustment in Congenital Heart Surgery (RACHS-1) method. The 2006 STS Congenital Heart Surgery Database Report, the first STS report to incorporate both methods, included 45,635 operations from 47 centers. Each operation was assigned an ABC score in a range from 1.5 (lowest complexity) to 15 (highest complexity), an ABC level in a range from 1 (lowest complexity) to 4 (highest complexity), and a RACHS-1 category in a range from 1 (lowest risk) to 6 (highest risk). The overall discharge mortality was 3.9% (1,222/31,719 eligible cardiac index operations). Of the eligible cardiac index operations, 85.8% (27,202/31,719) were eligible for analysis by the RACHS-1 method, and 94.0% (29,813/31,719) were eligible for analysis by the ABC approach. With both RACHS-1 and ABC, as complexity increases, discharge mortality also increases. The ABC approach allows classification of more operations, whereas the RACHS-1 discriminates better at the higher end of complexity. Complexity stratification is a useful method for analyzing the impact of case mix on pediatric cardiac surgical outcomes. Both the RACHS-1 and ABC methods facilitate complexity stratification in the STS database.
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页码：1117 / 1130
页数：13
相关论文
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