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Multicenter Study
. 2015 Sep;100(3):1063-8; discussion 1068-70.
doi: 10.1016/j.athoracsur.2015.07.011. Epub 2015 Aug 3.

The Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model: Part 2-Clinical Application

Jeffrey P Jacobs  1 , Sean M O'Brien  2 , Sara K Pasquali  3 , J William Gaynor  4 , John E Mayer Jr  5 , Tara Karamlou  6 , Karl F Welke  7 , Giovanni Filardo  8 , Jane M Han  9 , Sunghee Kim  2 , James A Quintessenza  10 , Christian Pizarro  11 , Christo I Tchervenkov  12 , Francois Lacour-Gayet  13 , Constantine Mavroudis  10 , Carl L Backer  14 , Erle H Austin 3rd  15 , Charles D Fraser  16 , James S Tweddell  17 , Richard A Jonas  18 , Fred H Edwards  19 , Frederick L Grover  20 , Richard L Prager  21 , David M Shahian  22 , Marshall L Jacobs  10
Affiliations
Multicenter Study

The Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model: Part 2-Clinical Application

Jeffrey P Jacobs et al. Ann Thorac Surg. 2015 Sep.

Abstract

Background: The empirically derived 2014 Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model incorporates adjustment for procedure type and patient-specific factors. The purpose of this report is to describe this model and its application in the assessment of variation in outcomes across centers.

Methods: All index cardiac operations in The Society of Thoracic Surgeons Congenital Heart Surgery Database (January 1, 2010, to December 31, 2013) were eligible for inclusion. Isolated patent ductus arteriosus closures in patients weighing less than or equal to 2.5 kg were excluded, as were centers with more than 10% missing data and patients with missing data for key variables. The model includes the following covariates: primary procedure, age, any prior cardiovascular operation, any noncardiac abnormality, any chromosomal abnormality or syndrome, important preoperative factors (mechanical circulatory support, shock persisting at time of operation, mechanical ventilation, renal failure requiring dialysis or renal dysfunction (or both), and neurological deficit), any other preoperative factor, prematurity (neonates and infants), and weight (neonates and infants). Variation across centers was assessed. Centers for which the 95% confidence interval for the observed-to-expected mortality ratio does not include unity are identified as lower-performing or higher-performing programs with respect to operative mortality.

Results: Included were 52,224 operations from 86 centers. Overall discharge mortality was 3.7% (1,931 of 52,224). Discharge mortality by age category was neonates, 10.1% (1,129 of 11,144); infants, 3.0% (564 of 18,554), children, 0.9% (167 of 18,407), and adults, 1.7% (71 of 4,119). For all patients, 12 of 86 centers (14%) were lower-performing programs, 67 (78%) were not outliers, and 7 (8%) were higher-performing programs.

Conclusions: The 2014 Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model facilitates description of outcomes (mortality) adjusted for procedural and for patient-level factors. Identification of low-performing and high-performing programs may be useful in facilitating quality improvement efforts.

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Figures

Fig 1
Fig 1
Distribution of hospital-specific observed-to-expected (O/E) ratios for operative mortality with 95% confidence intervals (gray lines).
See this image and copyright information in PMC

References

    1. Jacobs JP, Cerfolio RJ, Sade RM. The ethics of transparency: publication of cardiothoracic surgical outcomes in the lay press. Ann Thorac Surg. 2009;87:679–686. - PubMed
    1. Shahian DM, Edwards FH, Jacobs JP, et al. Public reporting of cardiac surgery performance: part 1–history, rationale, consequences. Ann Thorac Surg. 2011;92(3 Suppl):S2–S11. - PubMed
    1. Shahian DM, Edwards FH, Jacobs JP, et al. Public reporting of cardiac surgery performance: part 2–implementation. Ann Thorac Surg. 2011;92(3 Suppl):S12–S23. - PubMed
    1. O’Brien SM, Clarke DR, Jacobs JP, et al. An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg. 2009;138:1139–1153. - PubMed
    1. Jacobs JP, Jacobs ML, Maruszewski B, et al. Initial application in the EACTS and STS Congenital Heart Surgery Databases of an empirically derived methodology of complexity adjustment to evaluate surgical case mix and results. Eur J Cardiothorac Surg. 2012;42:775–780. - PMC - PubMed

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