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Application of a complication screening method to congenital heart surgery admissions: a preliminary report
Oscar J Benavidez1, Kimberlee Gauvreau, Emile Bacha
1Department of Cardiology, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA. Oscar.Benavidez@cardio.chboston.org
Insights
Unwanted patient events are frequent during congenital heart surgery, affecting 32% of admissions. Children undergoing complex surgeries face the highest risk of these complications, necessitating further study for prevention and severity assessment.
Area of Science:
- Pediatric Surgery
- Healthcare Quality Improvement
- Patient Safety
Background:
- Comprehensive screening for inpatient events is established, but detailed assessment of complication diagnoses in congenital heart surgery admissions is lacking.
- Understanding complication frequencies and associated patient factors is crucial for improving care in this vulnerable population.
Purpose of the Study:
- To examine the frequency of complication diagnoses in congenital heart surgery admissions using a screening method.
- To investigate the relationship between patient characteristics and complication diagnoses.
- To identify patient factors associated with an increased risk of complications.
Main Methods:
- Utilized the Healthcare Cost and Utilization Project Kids' Inpatient Database 2000 for data from congenital heart surgery admissions (age ≤20 years).
- Identified complication diagnoses using International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) codes.
- Employed Risk Adjustment for Congenital Heart Surgery (RACHS-1) categories and multivariate analyses to assess associations between case complexity, patient characteristics, and complication risk.
Main Results:
- Out of 12,717 admissions, 4014 (32%) had at least one complication diagnosis.
- Procedure-related complications were most common (75%), followed by device/implant/graft (21%), and drug/biologic (4%).
- Higher surgical case complexity (RACHS-1 categories 2-6) and older age (> or =12 years) were significantly associated with increased odds of complication diagnoses, while prematurity showed decreased odds.
Conclusions:
- A significant proportion of congenital heart surgery admissions experience complication diagnoses, highlighting frequent unwanted patient events.
- Children undergoing more complex congenital heart surgeries are at a substantially higher risk for these adverse events.
- Further research is essential to determine the preventability and severity of these complications to enhance patient outcomes.
Abstract:
There have been comprehensive screening methods developed to identify unwanted inpatient events. A comprehensive assessment of complication diagnoses during congenital heart surgery admissions has not been performed. We examined the frequency of complications identified by a complication screening method and their relationship to patient characteristics among congenital heart surgery admissions. Data were obtained from the Healthcare Cost and Utilization Project Kids' Inpatient Database 2000. Among congenital heart surgery admissions, age < or =20 years, we identified International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) codes indicating complication. Complication diagnoses were categorized as related to drug/biologic, procedures, devices, implants and grafts, and radiation. We used the Risk Adjustment for Congenital Heart Surgery risk categories (1-6) to examine the association between case complexity and complications. Multivariate analyses estimated the odds for a complication diagnosis by patient characteristics, including age, prematurity, chromosomal anomalies, noncardiac structural anomalies, and surgical risk category. Among 12,717 cases, 4014 (32%) had at least 1 complication diagnosis code. Procedure-related complication diagnoses represented 75% of complication diagnoses; device, implant, or graft represented 21%; drug/biologic represented 4% and radiation represented 0%. Multivariate analyses demonstrated that higher surgical case complexity and older age had a greater risk for a complication diagnosis: Risk Category 2, odds ratio (OR) 1.8; 3 OR 2.9; 4 OR 2.9; 5 OR 5.0; 6 OR 4.1, relative to category 1, all p < 0.01; age > or =12 years, OR 1.3, p < 0.001; <1 year OR 1.1, p = 0.31. Premature cases had decreased odds OR 0.4, p < 0.001. This complication screening method indicates that unwanted patient events occur frequently during congenital heart surgery admissions. Children undergoing complex congenital heart surgery are at greatest risk for these unwanted events. Further study of these events is needed to determine their preventability and severity.
