Adjusting for Congenital Heart Surgery Risk Using Administrative Data.
Document Type
Article
Publication Date
12-5-2023
Identifier
DOI: 10.1016/j.jacc.2023.09.826
Abstract
BACKGROUND: Congenital heart surgery (CHS) encompasses a heterogeneous population of patients and surgeries. Risk standardization models that adjust for patient and procedural characteristics can allow for collective study of these disparate patients and procedures.
OBJECTIVES: We sought to develop a risk-adjustment model for CHS using the newly developed Risk Stratification for Congenital Heart Surgery for ICD-10 Administrative Data (RACHS-2) methodology.
METHODS: Within the Kids' Inpatient Database 2019, we identified all CHSs that could be assigned a RACHS-2 score. Hierarchical logistic regression (clustered on hospital) was used to identify patient and procedural characteristics associated with in-hospital mortality. Model validation was performed using data from 24 State Inpatient Databases during 2017.
RESULTS: Of 5,902,538 total weighted hospital discharges in the Kids' Inpatient Database 2019, 22,310 pediatric cardiac surgeries were identified and assigned a RACHS-2 score. In-hospital mortality occurred in 543 (2.4%) of cases. Using only RACHS-2, the mortality mode had a C-statistic of 0.81 that improved to 0.83 with the addition of age. A final multivariable model inclusive of RACHS-2, age, payer, and presence of a complex chronic condition outside of congenital heart disease further improved model discrimination to 0.87 (P < 0.001). Discrimination in the validation cohort was also very good with a C-statistic of 0.83.
CONCLUSIONS: We created and validated a risk-adjustment model for CHS that accounts for patient and procedural characteristics associated with in-hospital mortality available in administrative data, including the newly developed RACHS-2. Our risk model will be critical for use in health services research and quality improvement initiatives.
Journal Title
Journal of the American College of Cardiology
Volume
82
Issue
23
First Page
2212
Last Page
2221
MeSH Keywords
Child; Humans; Infant; Cardiac Surgical Procedures; Heart Defects, Congenital; Risk Adjustment; Hospital Mortality; Logistic Models; Risk Factors; Retrospective Studies
Keywords
congenital heart surgery; outcomes; risk-adjustment
Recommended Citation
Jayaram N, Allen P, Hall M, et al. Adjusting for Congenital Heart Surgery Risk Using Administrative Data. J Am Coll Cardiol. 2023;82(23):2212-2221. doi:10.1016/j.jacc.2023.09.826
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