+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Interinstitutional comparison of risk-adjusted mortality and length of stay in congenital heart surgery



Interinstitutional comparison of risk-adjusted mortality and length of stay in congenital heart surgery



Annals of Thoracic Surgery 88(1): 151-156



Risk Adjustment for Congenital Heart Surgery (RACHS) and basic Aristotle scores (BCS) have been shown to correlate with mortality and length of stay (LOS) after congenital heart surgery. Interinstitutional comparisons using these scores, as well as comprehensive Aristotle score (CCS), have not been demonstrated. We recorded age, weight, RACHS, BCS, CCS, mortality, and LOS for 1,103 patients undergoing cardiac surgery between September 1, 2004, and June 1, 2007, at two institutions. We used binary logistic and multiple linear regressions to evaluate determinants of mortality and LOS, respectively, the C statistic to compare the predictive power of the three scoring systems for mortality, the odds ratio to compare the two institutions, and regression coefficients to compare scoring systems and institutions for LOS. Raw mortality was 2.9% at both institutions. Final logistic regression models contained only CCS. Odds ratios for death at institutions 1 and 2 were 1.25 and 1.26, respectively (not significant). C statistics for RACHS, BCS, and CCS were 0.73, 0.63, and 0.81, respectively (p = 0.01 for CCS versus BCS; p = 0.02 for CCS versus RACHS). Final regression model for LOS retained age, RACHS, and CCS (R(2) = 0.44). The RACHS regression coefficient was greater for institution 2. The CCS tends to have more predictive power than RACHS and BCS for mortality. The LOS is moderately correlated with CCS, RACHS, and age together, but the model is a poor predictor of individual LOS. The LOS for RACHS category 6 cases differed between the institutions. This study suggests methods that can be used to compare institutions in a risk-adjusted manner.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 053914250

Download citation: RISBibTeXText

PMID: 19559215

DOI: 10.1016/j.athoracsur.2009.03.080


Related references

Risk-adjusted prolonged length of stay as an alternative outcome measure for pediatric congenital cardiac surgery. Annals of Thoracic Surgery 97(6): 2154-2159, 2014

Institutional factors associated with risk-adjusted mortality for congenital heart surgery. Journal of the American College of Cardiology 37(2 Suppl. A): 468A, 2001

The RACHS-1 risk categories reflect mortality and length of stay in a Danish population of children operated for congenital heart disease. European Journal of Cardio-Thoracic Surgery 28(6): 877-881, 2005

Comparison of severity-adjusted intensive care mortality and length of stay in a VA and private sector hospitals. Journal of Investigative Medicine 47(7): 231A, 1999

Infections and risk-adjusted length of stay and hospital mortality in Polish Neonatology Intensive Care Units. International Journal of Infectious Diseases 35: 87-92, 2015

Type of Valvular Heart Disease Requiring Surgery in the 21st Century: Mortality and Length-of-Stay Related to Surgery. Open Cardiovascular Medicine Journal 7: 104-109, 2013

A Method to Account for Variation in Congenital Heart Surgery Length of Stay. Pediatric Critical Care Medicine 18(6): 550-560, 2017

Estimating Mortality Risk for Adult Congenital Heart Surgery: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database. Annals of Thoracic Surgery 100(5): 1728-35; Discussion 1735-6, 2016

Development and Validation of an Agency for Healthcare Research and Quality Indicator for Mortality After Congenital Heart Surgery Harmonized With Risk Adjustment for Congenital Heart Surgery (RACHS-1) Methodology. Journal of the American Heart Association 5(5):, 2016

Excess costs associated with complications and prolonged length of stay after congenital heart surgery. Annals of Thoracic Surgery 98(5): 1660-1666, 2014

Factors influencing length of hospital stay after surgery for congenital heart disease. Clinical Research 39(2): 410A, 1991

Predicting hospital charge and length of stay for congenital heart disease surgery. American Journal of Cardiology 72(12): 958-963, 1993

Predicting mortality after congenital heart surgeries: evaluation of the Aristotle and Risk Adjustement in Congenital Heart Surgery-1 risk prediction scoring systems: a retrospective single center analysis of 1150 patients. Annals of Cardiac Anaesthesia 17(4): 266-270, 2015

Gaming in risk-adjusted mortality rates: effect of misclassification of risk factors in the benchmarking of cardiac surgery risk-adjusted mortality rates. Journal of Thoracic and Cardiovascular Surgery 145(3): 781-789, 2013

Case-mix-adjusted length of stay and mortality in 23 Finnish ICUs. Intensive Care Medicine 35(6): 1060-1067, 2009