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RACHS - ANZ : A Modified Risk Adjustment in Congenital Heart Surgery Model for Outcome Surveillance in Australia and

Brent McSharry1, Lahn Straney2, Janet Alexander3

  • 11 Paediatric Intensive Care Unit Starship Children's Hospital Auckland New Zealand.

Journal of the American Heart Association
|May 2, 2019
PubMed

Insights

A new Risk Adjustment for Congenital Heart Surgery (RACHS) model for Australia and New Zealand (ANZ) accurately predicts pediatric cardiac surgery mortality, outperforming the original RACHS-1 model. This RACHS-ANZ model improves outcomes monitoring for pediatric heart surgery patients.

Area of Science:

  • Cardiology
  • Pediatric Surgery
  • Public Health

Background:

  • Pediatric cardiac surgery outcomes are often based on voluntary international data.
  • Population-based outcomes for all children within a region are less frequently reported.
  • Accurate outcome prediction is crucial for improving pediatric cardiac surgery care.

Purpose of the Study:

  • To describe bi-national, population-based outcomes for pediatric cardiac surgery in Australia and New Zealand.
  • To evaluate the accuracy of the Risk Adjustment for Congenital Heart Surgery (RACHS) classification in predicting in-hospital mortality.
  • To develop and validate an improved predictive model for this specific population.

Main Methods:

  • Analysis of 14,324 hospital admissions for pediatric cardiac surgery in Australia and New Zealand (2007-2015).
  • Assessment of the original RACHS-1 model's calibration and discrimination.
  • Development and validation of a new RACHS-ANZ model using 3 additional risk variables.

Main Results:

  • Overall hospital mortality was 2.3%, varying significantly by RACHS category (0.5% for category 1 to 17.0% for categories 5/6).
  • The original RACHS-1 model overpredicted mortality (1161 predicted vs. 289 observed deaths).
  • The RACHS-ANZ model demonstrated superior performance with excellent discrimination (Az-ROC 0.830) and good fit (P=0.216).

Conclusions:

  • The standard RACHS-1 model overestimates mortality in contemporary pediatric cardiac surgery.
  • The developed RACHS-ANZ model offers improved accuracy and broader applicability for predicting in-hospital mortality.
  • The RACHS-ANZ model is suitable for monitoring regional pediatric cardiac surgery outcomes effectively.

Keywords:
cardiac surgerycongenital heart diseaseoutcome and process assessmentpediatricrisk model

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