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Incorporating Comorbidity Within Risk Adjustment for UK Pediatric Cardiac Surgery

Katherine L Brown1, Libby Rogers2, David J Barron3

  • 1Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom.

The Annals of Thoracic Surgery
|March 21, 2017
PubMed

Insights

Risk adjustment for pediatric cardiac surgery survival must account for patient comorbidities. New risk factor groups, including non-Down congenital anomalies and acquired conditions, significantly impact operative mortality predictions.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Health Services Research

Background:

  • Accurate risk adjustment is crucial for assessing early survival rates after pediatric cardiac surgery.
  • Case complexity, particularly patient comorbidity, is a significant factor influencing outcomes but has been historically underestimated.
  • Understanding and quantifying comorbidity is essential for refining risk prediction models.

Purpose of the Study:

  • To develop and validate new groupings for comorbidity and other non-procedure-based risk factors.
  • To improve the accuracy of risk adjustment models for 30-day mortality following pediatric cardiac surgery.
  • To better understand the impact of various risk factors on operative mortality.

Main Methods:

  • Utilized data from the National Congenital Heart Disease Audit (2009-2014) encompassing all UK and Ireland pediatric cardiac surgeries.
  • Employed a combination of expert consensus and empirical statistical analyses to define and test novel comorbidity groupings.
  • Developed a risk adjustment model incorporating surgical procedure details and new non-procedure-based risk factors.

Main Results:

  • The study included 21,838 procedures in 18,834 patients, with a 2.5% 30-day mortality rate.
  • Identified several independent predictors of operative mortality beyond surgical factors: non-Down congenital anomalies, acquired comorbidities, indicators of severe illness (e.g., mechanical ventilation), and additional cardiac risk factors (e.g., cardiomyopathy, pulmonary hypertension).
  • These new risk factor groups significantly increased the risk of operative mortality.

Conclusions:

  • Non-procedure-based risk factors are critical components of risk adjustment in pediatric cardiac surgery.
  • In an era of generally low mortality, these factors explain significant variations in predicted operative risk.
  • Accurate risk adjustment requires comprehensive consideration of patient-specific comorbidities and conditions beyond the surgical procedure itself.
Abstract

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