Consensus-based method for risk adjustment for surgery for congenital heart disease
Consensus-based method for risk adjustment for surgery for congenital heart disease
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DOI：
10.1067/mtc.2002.119064
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发表时间：
2002-01-01
影响因子：
6
通讯作者：
Iezzoni, LI
中科院分区：
文献类型：
--
作者：
Jenkins, KJ;Gauvreau, K;Iezzoni, LI
其目的是制定一个基于共识的方法，对小于18岁的儿童先天性心脏病（指定RACIIS-1）手术后的住院死亡率进行风险调整：一个由11名儿童心脏病专家和心脏外科医生组成的国家小组使用临床判断将外科手术分为6个风险类别。在审查了儿科心脏护理联盟和三个全州医院出院数据集的信息后，对分类进行了改进。通过比较受试者-操作者特征曲线下的面积，探讨了包括额外临床变量的影响。在儿科心脏护理联盟数据集中的4602名手术患者和出院数据中的4493名患者中，3767名分别有81.9%和3832例（85.3%）接受了单一心脏手术，分别有98.5%和89.2%能够被分配到小组定义的六个风险类别之一。死亡率显示出预期趋势（P <0.001）。对于儿科心脏护理联盟的数据，1类死亡率为0.4%，2类为3.8%，3类为8.5%，4类为19.4%，6类为47.7%;出院数据中的死亡率相似。第5类病例太少，无法估计死亡率。在多变量模型中，年龄较小、早产和存在主要非心脏结构异常增加了仅按风险类别预测的院内死亡风险。最好的性能时，与多个程序的情况下，被放置在最复杂的procedure.Conclusion的风险类别：RACHS-1方法应调整基线风险差异，并允许有意义的比较，在医院的死亡率进行手术的儿童先天性心脏病组。
The aim was to develop a consensus-based method of risk adjustment for in-hospital mortality among children younger than 18 years after surgery for congenital heart disease (designated RACIIS-1).Methods: An 11-member national panel of pediatric cardiologists and cardiac surgeons used clinical judgment to place surgical procedures into six risk categories. , Categories were refined after review of information from the Pediatric Cardiac Care Consortium and three statewide hospital discharge data sets. The effects of including additional clinical variables were explored by comparing areas under receiver-operator characteristic curves.Results: Among 4602 surgical patients in the Pediatric Cardiac Care Consortium data set and 4493 in the hospital discharge data, 3767 (81.9%) and 3832 (85.3%), respectively, had a single cardiac procedure, and 98.5% and 89.2%, respectively, were able to be assigned to one of six risk categories defined by the panel. Mortality rates showed expected trends (P < .001). For the Pediatric Cardiac Care Consortium data, mortality rates were 0.4% in category 1, 3.8% in 2, 8.5% in 3, 19.4% in 4, and 47.7% in 6; rates were similar in the hospital discharge data. There were too few cases in category 5 to estimate mortality rates. In multivariable models, younger age, prematurity, and the presence of a major noncardiac structural anomaly added to the risk of in-hospital death predicted by risk category alone. Best performance was obtained when cases with multiple procedures were placed in the risk category of the most complex procedure.Conclusion: The RACHS-1 method should adjust for baseline risk differences and allow meaningful comparisons of in-hospital mortality for groups of children undergoing surgery for congenital heart disease.