The proposed risk scores and categories have a high degree of discrimination for predicting mortality and represent an improvement over existing consensus-based methods. Risk models incorporating these measures may be used to compare mortality outcomes across institutions with differing case mixes.

A complexity-adjusted method named the Aristotle Score, based on the complexity of the surgical procedures has been developed by an international group of experts. The Aristotle score, electronically available, was introduced in the EACTS and STS databases. A validation process evaluating its predictive value is being developed.

Background We evaluated outcomes for common operations in the STS Congenital Heart Surgery Database (STS-CHSDB) to provide contemporary benchmarks and examine variation between centers. Methods Patients undergoing surgery from 2005-2009 were included. Centers with>10% missing data were excluded. Discharge mortality and postoperative length of stay (PLOS) among patients discharged alive were calculated for eight benchmark operations of varying complexity. Power for analyzing between-center variation in outcome was determined for each operation. Variation was evaluated using funnel plots and Bayesian hierarchical modeling. Results 18,375 index operations at 74 centers were included in the analysis of eight benchmark operations. Overall discharge mortality (range) was: ventricular septal defect repair (VSD) 0.6% (0%–5.1%), tetralogy of Fallot repair (TOF) 1.1% (0%–16.7%), complete atrioventricular canal repair (AVC) 2.2% (0%–20%), arterial switch (ASO) 2.9% (0%–50%), ASO+VSD 7.0% (0%–100%), Fontan 1.3% (0%–9.1%), truncus repair 10.9% (0%–100%), Norwood 19.3% (2.9%–100%). Funnel plots revealed the number of centers characterized as outliers were: VSD=0, TOF=0, AVC=1, ASO=3, ASO+VSD=1, Fontan=0, Truncus=4, Norwood=11. Power calculations showed statistically meaningful comparisons of mortality rates between centers could only be made for Norwood, for which the Bayesian-estimated range (95% Probability Interval) was 7.0% (3.7%-10.3%) to 41.6% (30.6%-57.2%). Between-center variation in PLOS was analyzed for all operations and was larger for more complex operations. Conclusions This analysis documents contemporary benchmarks for common pediatric cardiac surgical operations and the range of outcomes among centers. Variation was most prominent for the more complex operations. These data may aid in quality assessment and quality improvement initiatives.

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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.