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Empirically Based Tools for Analyzing Mortality and Morbidity Associated with Congenital Heart Surgery

  • Marshall L. Jacobs
  • Sara K. Pasquali
  • Jeffrey P. Jacobs
  • Sean M. O’Brien
Chapter

Abstract

Congenital heart surgery outcomes analysis requires reliable methods of estimating the risk of adverse outcomes. In the past, methods used for risk adjusted comparisons of outcomes from congenital heart surgery relied on expert opinion about perceived complexity of treatment. The development and growth of national and international congenital heart surgery clinical registry databases has resulted in the availability of large datasets for analysis. The adoption by these registries of standardized nomenclature and definitions and their use of a uniform set of data elements has made it possible to apply robust statistical methodology to these large sets of objective data to develop empirically based tools for analysis of mortality and morbidity associated with congenital heart surgery. The Society of Thoracic Surgeons – European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Score and Categories (STAT Mortality Categories) and the Society of Thoracic Surgeons Congenital Heart Surgery Morbidity Score and Categories are now widely used in reporting of outcomes, in quality assessment, and in outcomes research.

Keywords

Database Outcomes Congenital heart disease Statistics Morbidity Mortality 

References

  1. 1.
    Shahian DM, Blackstone EH, Edwards FH, Grover FL, Grunkemeier GL, Naftel DC, Nashef SA, Nugent WC, Peterson ED. STS workforce on evidence-based surgery. Cardiac surgery risk models: a position article. Ann Thorac Surg. 2004;78(5):1868–77.PubMedCrossRefGoogle Scholar
  2. 2.
    Lacour-Gayet F, Clarke D, Jacobs J, Comas J, Daebritz S, Daenen W, Gaynor W, Hamilton L, Jacobs M, Maruszsewski B, Pozzi M, Spray T, Stellin G, Tchervenkov C, Mavroudis C, The Aristotle Committee. The Aristotle score: a complexity-adjusted method to evaluate surgical results. Eur J Cardiothorac Surg. 2004;25:911–24.PubMedCrossRefGoogle Scholar
  3. 3.
    Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg. 2002;123(1):110–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Jacobs JP, Jacobs ML, Lacour-Gayet FG, Jenkins KJ, Gauvreau K, Bacha E, Maruszewski B, Clarke DR, Tchervenkov CI, Gaynor JW, Spray TL, Stellin G, O’Bien SM, Elliott MJ, Mavroudis C. 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. Pediatr Cardiol. 2009;30(8):1117–30. doi: 10.1007/s00246-009-9496-0.PubMedCrossRefGoogle Scholar
  5. 5.
    O’Brien SM, Jacobs JP, Clarke DR, Maruszewski B, Jacobs ML, Walters HL, Tchervenkov CI, Welke KF, Tobota Z, Stellin G, Mavroudis C, Hamilton JR, Gaynor JW, Pozzi M, Lacour-Gayet FG. Accuracy of the Aristotle basic complexity score for classifying the mortality potential of congenital heart surgery operations. Ann Thorac Surg. 2007;84(6):2027–37.PubMedCrossRefGoogle Scholar
  6. 6.
    Blackstone EH. Let the data speak for themselves? Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2004;7:192–8.PubMedCrossRefGoogle Scholar
  7. 7.
    O’Brien SM, Clarke DR, Jacobs JP, Jacobs ML, Lacour-Gayet FG, Pizarro C, Welke KF, Maruszewski B, Tobota Z, Miller WJ, Hamilton L, Peterson ED, Mavroudis C, Edwards FH. An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg. 2009;138(5):1139–53.PubMedCrossRefGoogle Scholar
  8. 8.
    Jacobs JP, Jacobs ML, Maruszewski B, Lacour-Gayet FG, Tchervenkov CI, Tobota Z, Stellin G, Kurosawa H, Murakami A, Gaynor JW, Pasquali SK, Clarke DR, Austin 3rd EH, Mavroudis C. Initial application in the EACTS and STS Congenital Heart Surgery Databases of an empirically derived methodology of complexity adjustment to evaluate surgical case mix and results. Eur J Cardiothorac Surg. 2012;42(5):775–9.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Pasquali SK, He X, Jacobs JP, Jacobs ML, O’Brien SM, Gaynor JW. Evaluation of failure to rescue as a quality metric in pediatric heart surgery: an analysis of the STS congenital heart surgery database. Ann Thorac Surg. 2012;94(2):573–80.PubMedCrossRefGoogle Scholar
  10. 10.
    Jacobs JP, O’Brien SM, Pasquali SK, Jacobs ML, Lacour-Gayet FG, Tchervenkov CI, Austin 3rd EH, Pizarro C, Pourmoghadam KK, Scholl FG, Welke KF, Gaynor JW, Clarke DR, Mayer Jr JE, Mavroudis C. Variation in outcomes for risk-stratified pediatric cardiac surgical operations: an analysis of the STS congenital heart surgery database. Ann Thorac Surg. 2012;94(2):564–71.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Dibardino DJ, Pasquali SK, Hirsch JC, Benjamin DK, Kleeman KC, Salazar JD, Jacobs ML, Mayer JE, Jacobs JP. Effect of sex and race on outcome in patients undergoing congenital heart surgery: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg. 2012;94(6):2054–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Mascio CE, Austin 3rd EH, Jacobs JP, Jacobs ML, Wallace AS, He X, Pasquali SK. Perioperative mechanical circulatory support in children: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg. 2014;147(2):658–65.PubMedCrossRefGoogle Scholar
  13. 13.
    Jacobs JP, Jacobs ML, Austin EH, Mavroudis C, Pasquali SK, Lacour-Gayet F, Tchervenkov CI, Walters H, Bacha EA, del Nido PJ, Fraser CD, Gaynor JW, Hirsch JC, Morales DLS, Pourmoghadam KK, Tweddell JS, Prager RL, Mayer JE. Quality measures for congenital and pediatric cardiac surgery. World J Pediatr Congenit Heart Surg. 2012;3(1):32–47.PubMedCrossRefGoogle Scholar
  14. 14.
    RTI International. Methodology, U.S. News & World Report, Best Children’s Hospitals 2013–14. Available at: http://www.usnews.com/pubfiles/BCH_Methodology_2013-14.pdf. Accessed 23 Jan 2014.
  15. 15.
    Tsang VT, Brown KL, Synnergren MJ, Kang N, de Leval MR, Gallivan S, Utley M. Monitoring risk-adjusted outcomes in congenital heart surgery: does the appropriateness of a risk model change with time? Ann Thorac Surg. 2009;87(2):584–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Jacobs JP, Shahian DM, Jacobs ML, Mavroudis C. Invited commentary re: “monitoring risk-adjusted outcomes in congenital heart surgery: does the appropriateness of a risk model change with time?”. Ann Thorac Surg. 2009;87(2):587–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Mahle WT, Wernovsky G. Long-term developmental outcome of children with complex congenital heart disease. Clin Perinatol. 2001;28:235–47.PubMedCrossRefGoogle Scholar
  18. 18.
    Pasquali SK, Sun JL, d’Almada P, Jaquiss RD, Lodge AJ, Miller N, et al. Center variation in hospital costs for patients undergoing congenital heart surgery. Circ Cardiovasc Qual Outcomes. 2011;4:306–12.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Kolh P. Importance of risk stratification models in cardiac surgery. Eur Heart J. 2006;27:768–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Jacobs ML, O’Brien SM, Jacobs JP, Mavroudis C, Lacour-Gayet F, Pasquali SK, Welke K, Pizarro C, Tsai F, Clark DR. An empirically based tool for analyzing morbidity associated with operations for congenital heart disease. J Thorac Cardiovasc Surg. 2013;145(4):1046–57.PubMedCrossRefGoogle Scholar
  21. 21.
    Gupta P, Jacobs JP, Pasquali SK, Hill KD, Gaynor JW, O’Brien SM, He M, Sheng S, Schexnayder SM, Berg RA, Nadkarni VM, Imamura M, Jacobs ML. Epidemiology and outcomes following in-hospital cardiac arrest after pediatric cardiac surgery. Proceedings of 50th annual meeting of the Society of Thoracic Surgeons; Jan 2014. Available at: http://www.sts.org/sites/default/files/documents/pdf/annmtg/2014AM/50AM_AbstractBook.pdf.
  22. 22.
    Jacobs JP, Jacobs ML, Mavroudis C, Lacour-Gayet FG, Tchervenkov CI, Pasquali SK. Executive Summary: The Society of Thoracic Surgeons Congenital Heart Surgery Database – Nineteenth Harvest – (July 1, 2009 – June 30, 2013). The Society of Thoracic Surgeons (STS) and Duke Clinical Research Institute (DCRI), Duke University Medical Center, Durham; 2013 Harvest.Google Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  • Marshall L. Jacobs
    • 1
  • Sara K. Pasquali
    • 2
  • Jeffrey P. Jacobs
    • 3
    • 4
  • Sean M. O’Brien
    • 5
  1. 1.Division of Cardiac Surgery, Department of SurgeryJohns Hopkins School of MedicineBaltimoreUSA
  2. 2.Department of PediatricsC.S. Mott Children’s Hospital, University of Michigan Congenital Heart CenterAnn ArborUSA
  3. 3.Division of Cardiac Surgery, Department of SurgeryJohns Hopkins All Children’s Heart Institute, All Children’s Hospital and Florida Hospital for Children, Johns Hopkins UniversityTampa and OrlandoUSA
  4. 4.Division of Cardiac Surgery, Department of SurgeryJohns Hopkins UniversityBaltimoreUSA
  5. 5.Department of Biostatistics and BioinformaticsDuke University Medical CenterDurhamUSA

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