Procedure-Type Risk Categories for Pediatric and Congenital Cardiac Catheterization

Abstract

Background— The Congenital Cardiac Catheterization Project on Outcomes (C3PO) was established to develop outcome assessment methods for pediatric catheterization. Methods and Results— Six sites have been recording demographic, procedural and immediate outcome data on all cases, using a web-based system since February 2007. A sample of data was independently audited for validity and data completeness. In 2006, participants categorized 84 procedure types into 6 categories by anticipated risk of an adverse event (AE). Consensus and empirical methods were used to determine final procedure risk categories, based on the outcomes: any AE (level 1 to 5); AE level 3, 4, or 5; and death or life-threatening event (level 4 or 5). The final models were then evaluated for validity in a prospectively collected data set between May 2008 and December 31, 2009. Between February 2007 and April 2008, 3756 cases were recorded, 558 (14.9%) with any AE; 226 (6.0%) level 3, 4, or 5; and 73 (1.9%) level 4 or 5. General estimating equations models using 6 consensus-based risk categories were moderately predictive of AE occurrence (c-statistics: 0.644, 0.664, and 0.707). The participant panel made adjustments based on the collected empirical data supported by clinical judgment. These decisions yielded 4 procedure risk categories; the final models had improved discrimination, with c-statistics of 0.699, 0.725, and 0.765. Similar discrimination was observed in the performance data set (n=7043), with c-statistics of 0.672, 0.708, and 0.721. Conclusions— Procedure-type risk categories are associated with different complication rates in our data set and could be an important variable in risk adjustment models for pediatric catheterization.

Device Closure of Secundum Atrial Septal Defects in Children <15 kg

“…This is contrary to previous studies that only list death, stroke, or device erosion as major complications. Though the Bergersen et al study does include a comprehensive listing of complications, it does not stratify patients and the complications according to patient size (7,17). In 1 study of 52 patients, the investigators reported no major complications, yet discussed 2 device embolizations that were classified as minor complications (6).…”

Adjusting for Risk Associated With Pediatric and Congenital Cardiac Catheterization

“…A full description of procedure-type risk group development has been previously described in detail. 10 In brief, the procedure-type risk groups were created using data from the Congenital Cardiac Catheterization Project on Outcomes (C3PO) and were developed based on both expert consensus and empirically derived data. Four categories of procedural risk were created (Category 1= procedures associated with lowest risk vs. Category 4=procedures associated with highest risk).…”

Capture of Complexity of Specialty Care in Pediatric Cardiology by Work RVU Measures

“…10,13 Categories were developed by using expert judgment and empirical methods in a derivation cohort and validated in a prospective cohort in the Congenital Cardiac Catheterization Project on Outcomes database. A case is assigned to 1 category based on the characteristics of the case; for diagnostic procedures the cases are stratified by age group.…”