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The assessment of complexity in congenital cardiac surgery based on objective data

Part of: The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD)

Published online by Cambridge University Press:  01 December 2008

David R. Clarke ,
Francois Lacour-Gayet ,
Jeffrey Phillip Jacobs ,
Marshall L. Jacobs ,
Bohdan Maruszewski ,
Christian Pizarro ,
Fred H. Edwards  and
Constantine Mavroudis
David R. Clarke
Affiliation:
The Children’s Hospital, University of Colorado Denver School of Medicine, Aurora, Colorado
Francois Lacour-Gayet*
Affiliation:
The Children’s Hospital, University of Colorado Denver School of Medicine, Aurora, Colorado
Jeffrey Phillip Jacobs
Affiliation:
The Congenital Heart Institute of Florida (CHIF), Division of Thoracic and Cardiovascular Surgery, All Children’s Hospital and Children’s Hospital of Tampa, University of South Florida College of Medicine, Cardiac Surgical Associates (CSA), Saint Petersburg and Tampa, Florida, United States of America
Marshall L. Jacobs
Affiliation:
Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
Bohdan Maruszewski
Affiliation:
The Children’s Memorial Health Institute, Department of Cardiothoracic Surgery, Warsaw, Poland
Christian Pizarro
Affiliation:
Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States of America
Fred H. Edwards
Affiliation:
The University of Florida, Gainesville, Florida, United States of America
Constantine Mavroudis
Affiliation:
Children’s Memorial Hospital, Northwestern University School of Medicine, Chicago, Illinois, United States of America
*
Correspondence to: Francois Lacour-Gayet, MD, Professor of Surgery, University of Colorado School of Medicine, The Children’s Hospital in Denver, 13123 E. 16th Avenue. Aurora. CO80045, United States of America. Tel: +1 720 777 3376; Fax: +1 720 777 7271; E-mail: lacour-gayet.francois@tchden.org
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Abstract

When designed in 2000, the Aristotle Complexity Score was entirely based on subjective probability. This approach, based on the opinion of experts, was considered a good solution due to the limited amount of data available. In 2008, the next generation of the complexity score will be based on observed data available from over 100,000 congenital cardiac operations currently gathered in the congenital cardiac surgery databases of the Society of Thoracic Surgeons and the European Association for Cardio-Thoracic Surgery.

A mortality score is created based on 70,000 surgeries harvested in the congenital databases of The Society of Thoracic Surgeons and The European Association for Cardio-Thoracic Surgery. It is derived from 118 congenital cardiovascular operations, representing 91% of the operations and including 97% of the patients. This Mortality Index of the new Aristotle Complexity Score could further be stratified into 5 levels with minimal within-group variation and maximal between-group variation, and may contribute to the planned unification of the Aristotle Complexity Score with the Risk Adjustment for Congenital Heart Surgery system.

Similarly, a score quantifying morbidity risk is created. Due to the progress of congenital cardiac surgery, the mortality is today reduced to an average of 4%. No instrument currently exists to measure the quality of care delivered to the survivors representing 96% of the patients. An objective assessment of morbidity was needed. The Morbidity Index, based on 50,000 operations gathered in the congenital databases of The Society of Thoracic Surgeons and The European Association for Cardio-Thoracic Surgery, is derived from 117 congenital cardiovascular operations representing 90% of the operations and including 95% of the patients. This morbidity indicator is calculated on an algorithm based on length of stay in the hospital and time on the ventilator.

The mortality and morbidity indicators will be part of the next generation of the complexity score, which will be named the Aristotle Average Complexity Score. It will be based on the sum of mortality, morbidity, and subjective technical difficulty. The introduction of objective data in assessment of mortality and morbidity in congenital cardiac surgery is a significant step forward, which should allow a better evaluation of the complexity of the operations performed by a given centre or surgeon.

Keywords

Congenital heart diseasemortalitymorbiditycomplicationssurgical outcomesregistrydatabase

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