Risk Models for Monitoring Postoperative Complication Rates After Paediatric Cardiac Surgery.

Area of Science:

• Pediatric Cardiac Surgery
• Health Outcomes Research
• Quality Assurance Metrics

Background:

• Pediatric cardiac surgery has low mortality rates, shifting focus to postoperative complications.
• Complications significantly impact children's health and well-being post-surgery.
• Effective monitoring requires robust risk adjustment methods.

Purpose of the Study:

• To develop and evaluate risk adjustment models for 6 key postoperative complications in pediatric cardiac surgery.
• To enable reliable monitoring of complication rates for quality assurance.
• To address the complexity of complications as outcome measures compared to mortality.

Main Methods:

• Utilized national registry data from England and Wales (2015-2021).
• Developed risk adjustment models for 6 defined postoperative complications.
• Evaluated model performance using area under the curve (AUC) statistics.

Main Results:

• Analyzed 23,423 postoperative episodes in children (<18 years).
• Identified complication rates: necrotizing enterocolitis (1.9%), prolonged pleural effusion (1.3%), acute neurological events (2.2%), extracorporeal life support (1.9%), renal replacement therapy (3.6%), and unplanned reinterventions (4.3%).
• Models for pleural effusion, extracorporeal life support, and renal replacement showed high performance (AUC >0.85); others were less accurate (AUC 0.74-0.79).

Conclusions:

• National registry data can capture postoperative complications in pediatric cardiac surgery.
• Risk adjustment models are feasible for monitoring these complex outcomes.
• Developed methods support future risk-adjusted quality assurance for pediatric cardiac surgery outcomes.