RACHS-ANZ: A Modified Risk Adjustment in Congenital Heart Surgery Model for Outcome Surveillance in Australia and New Zealand
RACHS-ANZ: A Modified Risk Adjustment in Congenital Heart Surgery Model for Outcome Surveillance in Australia and New Zealand
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DOI：
10.1161/jaha.118.011390
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发表时间：
2019-05-07
影响因子：
5.4
通讯作者：
Slater, Anthony
中科院分区：
文献类型：
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作者：
McSharry, Brent;Straney, Lahn;Slater, Anthony
背景-小儿心脏手术的结果通常来自自愿提交的国际数据库。一个国家或地区所有儿童的手术结果报告较少。我们的目的是描述澳大利亚和新西兰接受心脏手术的儿童的两国人群结局，并确定先天性心脏手术风险调整（RACHS）分类是否可用于创建准确预测该人群住院死亡率的模型。这项研究是在2007年1月至2015年12月期间在澳大利亚和新西兰进行心脏手术的所有儿童医院进行的。原始RACHS-1模型的性能进行了评估，并与替代RACHS-ANZ（澳大利亚和新西兰）模型，开发平衡歧视与吝啬的变量选择。共分析了14324例住院病例。总体住院死亡率为2.3%，范围从RACHS 1类手术的0.5%至RACHS 5或6类手术的17.0%。最初的RACHS-1模型校准不良，死亡预测过高（预测1161例死亡，观察289例死亡）。RACHS-ANZ模型在这一人群中有更好的表现，具有出色的区分力（Az-ROC为0.830）和可接受的Hosmer和Lemeshow拟合优度（P=0.216）。RACHS-ANZ模型除RACHS手术类别外，仅需要3个风险变量，可应用于比RACHS-1更广泛的患者，适用于监测局部小儿心脏手术结局。
Background-Outcomes for pediatric cardiac surgery are commonly reported from international databases compiled from voluntary data submissions. Surgical outcomes for all children in a country or region are less commonly reported. We aimed to describe the bi-national population-based outcome for children undergoing cardiac surgery in Australia and New Zealand and determine whether the Risk Adjustment for Congenital Heart Surgery (RACHS) classification could be used to create a model that accurately predicts in-hospital mortality in this population.Methods and Results-The study was conducted in all children's hospitals performing cardiac surgery in Australia and New Zealand between January 2007 and December 2015. The performance of the original RACHS-1 model was assessed and compared with an alternative RACHS-ANZ (Australia and New Zealand) model, developed balancing discrimination with parsimonious variable selection. A total of 14 324 hospital admissions were analyzed. The overall hospital mortality was 2.3%, ranging from 0.5% for RACHS category 1 procedures, to 17.0% for RACHS category 5 or 6 procedures. The original RACHS-1 model was poorly calibrated with death overpredicted (1161 deaths predicted, 289 deaths observed). The RACHS-ANZ model had better performance in this population with excellent discrimination (Az-ROC of 0.830) and acceptable Hosmer and Lemeshow goodness-of-fit (P=0.216).Conclusions-The original RACHS-1 model overpredicts mortality in children undergoing heart surgery in the current era. The RACHS-ANZ model requires only 3 risk variables in addition to the RACHS procedure category, can be applied to a wider range of patients than RACHS-1, and is suitable to use to monitor regional pediatric cardiac surgery outcomes.