The RACHS-1 risk categories reflect mortality and length of stay in a Danish population of children operated for congenital heart disease☆

Larsen, Steffen Falgreen; Pedersen, John; Jacobsen, Jacob; Johnsen, Søren Paaske; Hansen, Ole Kromann; Hjortdal, Vibeke E.

doi:10.1016/j.ejcts.2005.09.008

Cited by 85 publications

(63 citation statements)

References 12 publications

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“…The patient's age and weight were not linked to successful fast tracking; however, these are currently the selection criteria used for entry into the fasttrack programme, with exclusion of smaller infants. As reported elsewhere [12,13], there was some indication of variation in hospital stay based on operative procedure, but the small difference observed of less than 1 day between groups was not considered clinically important in this series. The overall length of hospital stay significantly reduced since the programme began in 2006.…”

Section: Discussionsupporting

confidence: 59%

Fast-track paediatric cardiac surgery: the feasibility and benefits of a protocol for uncomplicated cases

Howard

Brown

Garside

et al. 2010

European Journal of Cardio-Thoracic Surgery

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Section: Discussionsupporting

confidence: 59%

Fast-track paediatric cardiac surgery: the feasibility and benefits of a protocol for uncomplicated cases

Howard

Brown

Garside

et al. 2010

European Journal of Cardio-Thoracic Surgery

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“…The key findings were that the mean weight for age for the PICU was significantly lower than the UK population mean; that patients with highest and lowest categories of weight for age (difference between the child's weight and the UK mean for age is more than 3.5 standard deviations) had the highest mortality; and the patients in the mild to moderately overweight for age category had the lowest mortality. This finding is in keeping with previous paediatric data from Australia [10] (where Numa et al also reported a ''U-shaped'' mortality curve when related to weight for age centiles); from the USA [11] where obesity was not associated with increased mortality or morbidity and from Denmark where low weight was a predictor of mortality following cardiac surgery [12].…”

supporting

confidence: 90%

Big babies and big adults surprise us by their outcomes: why?

Argent

Nadel

2014

Intensive Care Med

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“…It was even higher than in prior reports. 4,12,14 Risk adjustment is important to accurately compare in-hospital mortality. 4,15 This method would be useful for similar programs in the developing world.…”

Section: Discussionmentioning

confidence: 99%

Improvement in Congenital Heart Surgery in a Developing Country

et al. 2007

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Background— In 1997, an effort was made to disseminate US pediatric cardiac surgical practices to create a new comprehensive program in Guatemala. The objective of this study was to describe the improvement of the program by exploring the reduction in risk-adjusted in-hospital mortality. Methods and Results— A retrospective cohort study of surgical procedures performed in Guatemala from February 1997 to July 2004 was conducted. Data were divided into 3 time periods (1997 to 1999, 2000 to 2002, and 2003 to 2004) and compared with a US benchmark (2000 Kids’ Inpatient Database of 27 states and 313 institutions). The risk adjustment for congenital heart surgery (RACHS-1) method was used to adjust for case mix. Mortality rates, standardized mortality ratios, and 95% confidence intervals were calculated. A total of 1215 surgical procedures were included. Median age was 3.1 years (range, 1 day to 17.9 years). The overall mortality was 10.7% (n=130). The RACHS-1 method showed better discrimination than in prior reports (area under receiver operating characteristic curve=0.854). A decreasing trend in mortality rate was observed in every RACHS-1 risk category over the 3 time periods. When compared against the US benchmark, the reduction in risk-adjusted mortality was noted by a decrease of standardized mortality ratio from 10.0 (95% confidence interval, 7.2 to 13.7) in 1997–1999, to 7.8 (95% confidence interval, 5.9 to 10.0) in 2000–2002, and to 5.7 (95% confidence interval, 3.8 to 8.3) in 2003–2004. Conclusions— In a short time period, mortality after congenital heart surgery has been reduced substantially in Guatemala. Measurement of risk-adjusted mortality is a useful method to assess pediatric cardiac program improvement in the developing world.

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The RACHS-1 risk categories reflect mortality and length of stay in a Danish population of children operated for congenital heart disease☆

Abstract: The RACHS-1 classification can also be used to predict in-hospital mortality and length of stay in the Intensive Care Unit in a small volume centre.

Cited by 85 publications

References 12 publications

Fast-track paediatric cardiac surgery: the feasibility and benefits of a protocol for uncomplicated cases

Fast-track paediatric cardiac surgery: the feasibility and benefits of a protocol for uncomplicated cases

Big babies and big adults surprise us by their outcomes: why?

Improvement in Congenital Heart Surgery in a Developing Country

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