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Reclassifying by highest complexity operation rather than first operation influences mortality after pediatric heart
Punkaj Gupta1, Mallikarjuna Rettiganti2, Takeshi Shinkawa3
1Section of Cardiac Critical Care, Methodist Children's Hospital, San Antonio, Tex; Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark.
The Journal of Thoracic and Cardiovascular Surgery
|August 22, 2018
Summary
Reclassifying pediatric heart reoperations by highest complexity, not the initial surgery, significantly alters patient numbers and mortality rates across risk categories. This impacts how surgical outcomes are reported.
Area of Science:
- Pediatric Cardiac Surgery
- Surgical Outcomes Research
- Healthcare Data Analysis
Background:
- Accurate classification of pediatric heart reoperations is crucial for understanding surgical risk and outcomes.
- Current classification methods may not fully capture the complexity of reoperative procedures in children.
- The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) mortality categories provide a framework for risk stratification.
Purpose of the Study:
- To evaluate the impact of reclassifying pediatric heart reoperations based on highest procedural complexity versus the initial operation.
- To assess how different classification methods affect the distribution of patients across STAT mortality risk categories.
- To compare reported mortality rates between the two classification approaches in pediatric heart reoperations.
Main Methods:
- Analysis of data from the Virtual Pediatric Systems Database (2009-2015) for pediatric patients (<18 years) undergoing heart reoperations during the same hospitalization.
- Patients were classified using two methods: by the index (first) operation and by the operation with the highest STAT mortality category.
- Comparison of patient numbers and mortality rates across STAT categories for both classification methods.
Main Results:
- Classifying by the index operation resulted in approximately 2.5 times more patients in the lowest risk STAT category (STAT 1) compared to classification by highest complexity.
- Classification by highest complexity shifted patient distribution to other STAT categories.
- Higher mortality rates were observed across all STAT categories when patients were classified by index operation versus highest complexity.
Conclusions:
- The method used to classify pediatric heart reoperations significantly influences the number of patients assigned to each risk category and their reported mortality.
- Classifying reoperations by the highest complexity provides a different perspective on patient distribution and associated mortality compared to using the index operation.
- These findings highlight the importance of consistent and appropriate classification methods for accurate reporting of outcomes in pediatric cardiac surgery.
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