Adjusting for Congenital Heart Surgery Risk Using Administrative Data

Natalie Jayaram*, Philip Allen, Matthew Hall, Tara Karamlou, Joyce Woo, Sarah Crook, Brett R. Anderson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Congenital heart surgery (CHS) encompasses a heterogeneous population of patients and surgeries. Risk standardization models that adjust for patient and procedural characteristics can allow for collective study of these disparate patients and procedures. Objectives: We sought to develop a risk-adjustment model for CHS using the newly developed Risk Stratification for Congenital Heart Surgery for ICD-10 Administrative Data (RACHS-2) methodology. Methods: Within the Kids’ Inpatient Database 2019, we identified all CHSs that could be assigned a RACHS-2 score. Hierarchical logistic regression (clustered on hospital) was used to identify patient and procedural characteristics associated with in-hospital mortality. Model validation was performed using data from 24 State Inpatient Databases during 2017. Results: Of 5,902,538 total weighted hospital discharges in the Kids’ Inpatient Database 2019, 22,310 pediatric cardiac surgeries were identified and assigned a RACHS-2 score. In-hospital mortality occurred in 543 (2.4%) of cases. Using only RACHS-2, the mortality mode had a C-statistic of 0.81 that improved to 0.83 with the addition of age. A final multivariable model inclusive of RACHS-2, age, payer, and presence of a complex chronic condition outside of congenital heart disease further improved model discrimination to 0.87 (P < 0.001). Discrimination in the validation cohort was also very good with a C-statistic of 0.83. Conclusions: We created and validated a risk-adjustment model for CHS that accounts for patient and procedural characteristics associated with in-hospital mortality available in administrative data, including the newly developed RACHS-2. Our risk model will be critical for use in health services research and quality improvement initiatives.

Original languageEnglish (US)
Pages (from-to)2212-2221
Number of pages10
JournalJournal of the American College of Cardiology
Volume82
Issue number23
DOIs
StatePublished - Dec 5 2023

Keywords

  • congenital heart surgery
  • outcomes
  • risk-adjustment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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