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. 2013 Apr;145(4):1046-1057.e1.
doi: 10.1016/j.jtcvs.2012.06.029. Epub 2012 Jul 24.

An empirically based tool for analyzing morbidity associated with operations for congenital heart disease

Marshall L Jacobs  1 , Sean M O'Brien  2 , Jeffrey P Jacobs  3 , Constantine Mavroudis  4 , Francois Lacour-Gayet  5 , Sara K Pasquali  6 , Karl Welke  7 , Christian Pizarro  8 , Felix Tsai  9 , David R Clarke  10
Affiliations

An empirically based tool for analyzing morbidity associated with operations for congenital heart disease

Marshall L Jacobs et al. J Thorac Cardiovasc Surg. 2013 Apr.

Abstract

Objective: Congenital heart surgery outcomes analysis requires reliable methods of estimating the risk of adverse outcomes. Contemporary methods focus primarily on mortality or rely on expert opinion to estimate morbidity associated with different procedures. We created an objective, empirically based index that reflects statistically estimated risk of morbidity by procedure.

Methods: Morbidity risk was estimated using data from 62,851 operations in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2002-2008). Model-based estimates with 95% Bayesian credible intervals were calculated for each procedure's average risk of major complications and average postoperative length of stay. These 2 measures were combined into a composite morbidity score. A total of 140 procedures were assigned scores ranging from 0.1 to 5.0 and sorted into 5 relatively homogeneous categories.

Results: Model-estimated risk of major complications ranged from 1.0% for simple procedures to 38.2% for truncus arteriosus with interrupted aortic arch repair. Procedure-specific estimates of average postoperative length of stay ranged from 2.9 days for simple procedures to 42.6 days for a combined atrial switch and Rastelli operation. Spearman rank correlation between raw rates of major complication and average postoperative length of stay was 0.82 in procedures with n greater than 200. Rate of major complications ranged from 3.2% in category 1 to 30.0% in category 5. Aggregate average postoperative length of stay ranged from 6.3 days in category 1 to 34.0 days in category 5.

Conclusions: Complication rates and postoperative length of stay provide related but not redundant information about morbidity. The Morbidity Scores and Categories provide an objective assessment of risk associated with operations for congenital heart disease, which should facilitate comparison of outcomes across cohorts with differing case mixes.

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Figures

FIGURE E1
FIGURE E1
The relationship between the number of categories and the degree of within-category homogeneity. Within-category homogeneity is defined as 1 minus the ratio of within-category variance to total variance of procedure-specific morbidity estimates.
FIGURE 1
FIGURE 1
Unadjusted average PLOS (days) and unadjusted rate of major complications (percentage) are measured on the horizontal and vertical axes, respectively. Squares represent the 140 procedure types with n greater than 10. PLOS, Postoperative length of stay.
FIGURE 2
FIGURE 2
The proportions (%) of Any Major Complication and of Any Major Complication or Mortality are measured on the horizontal and vertical axes, respectively. The squares represent the 140 procedure types with n greater than 10.
FIGURE 3
FIGURE 3
The relationship between the STS-EACTS Mortality score and the STS Morbidity Score. Squares represent the 140 procedure types with n greater than 10.
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References

    1. Jacobs JP, O’Brien SM, Pasquali SK, Jacobs ML, Lacour-Gayet FG, Tchervenkov CI, et al. Variation in outcomes for benchmark operations: an analysis of The Society of Thoracic Surgeons’ Congenital Heart Surgery Database. Ann Thorac Surg. 2011;92:2184–92. - PMC - PubMed
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