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

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.

Morbidity in congenital heart surgery in a public hospital in Argentina

“…It identified five risk categories of increasing morbidity risk stratified depending on the complexity of the surgery: category 1 for minor risk procedures and 5 for major risk ones. 8 The four remaining events were selected by the authors because of their potential impact on mortality, length of stay, and special home care requirements.…”

“…[4][5][6] For this reason, in recent years, several instruments have been developed to measure morbidity and establish reference standards to make comparisons and assess performance at different sites. [7][8][9] In Argentina, there are no data available on the prevalence of complications in this population. Available local results would mean an advance in outcome quality.…”

Vasoactive-Ventilation-Renal Score Predicts Cardiac Care Unit Length of Stay in Patients Undergoing Re-Entry Sternotomy: A Derivation Study

“…Preoperative data collected included age, height and weight at the time of surgery, anatomic diagnosis, race, gender, genetic and chromosomal abnormalities, presence of non-cardiac abnormalities, need for preoperative ventilation, and preoperative serum creatinine. Perioperative data included operation performed, cardiopulmonary bypass time, aortic cross-clamp time, duration of deep hypothermic circulatory arrest, and Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery (STAT) mortality category [9]. Need for ECMO, nitric oxide, and/or delayed sternal closure were recorded.…”

Biomarkers in cardiovascular surgery biomarkers as early predictors for organ damage after cardiac surgery

“…İlgili yanıt ya da karakteristiği istatistiksel olarak güçlü olmalıdır. Günümüzde güvenli klinik biyo-belirteç-ler gen teknolojileri ve proteomiks teknikleriyle tespit edilmektedir (1)(2)(3)(4) Açık kalp operasyonları sonrası KPB'ın doku ve organlar üzerinde oluşturduğu hücresel boyuttan majör klinik boyuta kadar olan negatif etki özellikle bazı organlarda özgün olarak hasar yaratır. Bunlar özellikle, kalp, beyin, akciğer, böbrek, karaciğer ve diğer organlar üzerine olumsuz etkilerle kliniğe yansır.…”

“…Ameliyat sonrası erken dönemde morbidite ve mortalitenin en önemli nedeni olan bu hasarların erken dönemde tanınmasında son yıllarda birçok biyo-belirteç-den yararlanılmaktadır (1)(2)(3)(4). Bunlar sayesinde daha kalıcı hasar oluşmadan önlem alınabilmekte ve ameliyat sonrası morbidite ve mortalite azalmaktadır.…”