Stratification of Complexity Improves the Utility and Accuracy of Outcomes Analysis in a Multi-Institutional Congenital Heart Surgery Database: Application of the Risk Adjustment in Congenital Heart Surgery (RACHS-1) and Aristotle Systems in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database
Stratification of Complexity Improves the Utility and Accuracy of Outcomes Analysis in a Multi-Institutional Congenital Heart Surgery Database: Application of the Risk Adjustment in Congenital Heart Surgery (RACHS-1) and Aristotle Systems in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database
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DOI：
10.1007/s00246-009-9496-0
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发表时间：
2009-11-01
影响因子：
1.6
通讯作者：
Mavroudis, Constantine
中科院分区：
文献类型：
--
作者：
Jacobs, Jeffrey P.;Jacobs, Marshall L.;Mavroudis, Constantine
护理质量评估必须考虑到“病例组合”的变化。本研究回顾了两种病例组合复杂性调整工具在胸外科医师协会（STS）先天性心脏手术数据库中的应用：亚里士多德基本复杂性（ABC）评分和先天性心脏手术风险调整（RACHS-1）方法。2006年STS先天性心脏手术数据库报告是第一份包含两种方法的STS报告，包括来自47个中心的45，635例手术。每个操作都被分配了一个范围从1.5（最低复杂性）到15（最高复杂性）的ABC分数，一个范围从1（最低复杂性）到4（最高复杂性）的ABC等级，以及一个范围从1（最低风险）到6（最高风险）的RACHS-1类别。总体出院死亡率为3.9%（1，222/31，719例合格心脏指数手术）。在符合条件的心脏指数手术中，85.8%（27，202/31，719）符合RACHS-1方法分析的条件，94.0%（29，813/31，719）符合ABC方法分析的条件。对于RACHS-1和ABC，随着复杂性的增加，出院死亡率也增加。ABC方法允许对更多的操作进行分类，而RACHS-1在复杂性的高端更好地进行区分。复杂性分层是分析病例组合对小儿心脏手术结局影响的一种有用方法。RACHS-1和ABC方法都有助于STS数据库的复杂性分层。
Quality-of-care evaluation must take into account variations in "case mix." This study reviewed the application of two case-mix complexity-adjustment tools in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database: the Aristotle Basic Complexity (ABC) score and the Risk Adjustment in Congenital Heart Surgery (RACHS-1) method. The 2006 STS Congenital Heart Surgery Database Report, the first STS report to incorporate both methods, included 45,635 operations from 47 centers. Each operation was assigned an ABC score in a range from 1.5 (lowest complexity) to 15 (highest complexity), an ABC level in a range from 1 (lowest complexity) to 4 (highest complexity), and a RACHS-1 category in a range from 1 (lowest risk) to 6 (highest risk). The overall discharge mortality was 3.9% (1,222/31,719 eligible cardiac index operations). Of the eligible cardiac index operations, 85.8% (27,202/31,719) were eligible for analysis by the RACHS-1 method, and 94.0% (29,813/31,719) were eligible for analysis by the ABC approach. With both RACHS-1 and ABC, as complexity increases, discharge mortality also increases. The ABC approach allows classification of more operations, whereas the RACHS-1 discriminates better at the higher end of complexity. Complexity stratification is a useful method for analyzing the impact of case mix on pediatric cardiac surgical outcomes. Both the RACHS-1 and ABC methods facilitate complexity stratification in the STS database.