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Publicly Available Risk Stratification Tool for Congenital Heart Surgery

Authors :
Allen, Philip
Zafar, Farhan
Mi, Junhui
Crook, Sarah
Woo, Joyce
Jayaram, Natalie
Bryant, Roosevelt
Karamlou, Tara
Tweddell, James
Dragan, Kacie
Cook, Stephen
Hannan, Edward L.
Newburger, Jane W.
Bacha, Emile A.
Vincent, Robert
Nguyen, Khanh
Walsh-Spoonhower, Kathleen
Mosca, Ralph
Devejian, Neil
Kamenir, Steven A.
Alfieris, George M.
Swartz, Michael F.
Meyer, David
Paul, Erin A.
Billings, John
Anderson, Brett R.
Source :
J Am Coll Cardiol
Publication Year :
2022

Abstract

BACKGROUND: As the cardiac community strives to improve outcomes, accurate methods of risk adjustment are imperative. Since adoption of International Disease Classification-10 (ICD-10) in 2015, there is no published method for congenital heart surgery risk stratification for administrative data. OBJECTIVES: Our objective was to develop an empirically derived, publicly available, Risk Stratification for Congenital Heart Surgery (RACHS-2) tool for ICD-10 administrative data. METHODS: The RACHS-2 stratification system was iteratively and empirically refined in a training dataset of Pediatric Health Information Systems claims to optimize sensitivity and specificity when compared to corresponding, locally-held Society of Thoracic Surgeons-Congenital Heart Surgery (STS-CHS) clinical registry data. The tool was validated in a second administrative data source, New York State Medicaid claims. Logistic regression was used to compare the ability of RACHS-2 in administrative data to predict operative mortality vs. STAT Mortality Categories in registry data. RESULTS: The RACHS-2 system captured 99.6% of total congenital heart surgery registry cases, with 1.0% false positives. RACHS-2 predicted operative mortality in both training and validation administrative datasets similarly to STAT Mortality Categories in registry data. C-statistics for models for operative mortality in training and validation administrative datasets—adjusted for RACHS-2—were 0.76 and 0.84 (95% CIs 0.72-0.80 and 0.80-0.89); C-statistics for models for operative mortality—adjusted for STAT Mortality Categories—in corresponding clinical registry data were 0.75 and 0.84 (95% CIs 0.71-0.79 and 0.79-0.89). CONCLUSIONS: RACHS-2 is a risk stratification system for pediatric cardiac surgery for ICD-10 administrative data, validated in two administrative/registry linked datasets. Statistical code is publicly available upon request.

Details

Language :
English
Database :
OpenAIRE
Journal :
J Am Coll Cardiol
Accession number :
edsair.pmid..........9730715f38f5f61f4022398f05d8b678