Faculty Collaboration Database

Reclassifying by highest complexity operation rather than first operation influences mortality after pediatric heart surgery. J Thorac Cardiovasc Surg 2018 Nov;156(5):1961-1967.e9

Date

08/22/2018

Pubmed ID

30126659

DOI

10.1016/j.jtcvs.2018.06.035

Scopus ID

2-s2.0-85051649658 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

OBJECTIVE: To evaluate the effect on mortality of reclassifying patients undergoing pediatric heart reoperations of varying complexity by operation of highest complexity instead of by first operation.

METHODS: Data from the Virtual Pediatric Systems Database on children aged < 18 years who underwent heart surgery (with or without cardiopulmonary bypass) were included (2009-2015). Only patients who underwent reoperations during the same hospitalization were included. Patients were classified based on the first cardiovascular operation (the index operation), and on the complexity of the operation (the operation with the highest Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery [STAT] mortality category of each hospital admission) performed.

RESULTS: Of 51,047 patients (73 centers), 22,393 met inclusion criteria. Using index operation as the classifying operation, the number of patients classified in the STAT 1 category increased by approximately 2.5 times compared with the highest-complexity operation (index, 7,077 and highest complexity, 2,654). In contrast, when the highest-complexity classification was used, we noted an increase in the number of patients in other STAT categories. We also noted higher mortality in all STAT categories when patients were classified by index operation instead of by highest complexity (index vs highest STAT category 1, 0.6% vs 0.2%; category 2, 2.4% vs 0.8%; category 3, 3.1% vs 2.1%; category 4, 5.8% vs 5.6%; and category 5, 16.7% vs 16.5%).

CONCLUSIONS: This study demonstrates differences in the reported number of patients and reported mortality in each STAT category among children undergoing various heart reoperations during the same hospitalization by classifying patients based on index operation compared with the operation of highest complexity.

Author List

Gupta P, Rettiganti M, Shinkawa T, Gossett JM, Brundage N, Jeffries HE, Bertrandt RA

Author

Rebecca Ann Bertrandt MD Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Age Factors
Cardiac Surgical Procedures
Child
Child, Preschool
Databases, Factual
Female
Hospital Mortality
Humans
Infant
Infant, Newborn
Male
Quality Indicators, Health Care
Reoperation
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States
Young Adult