Risk Stratification for Congenital Heart Surgery for ICD-10 Administrative Data (RACHS-2)

Philip Allen; Farhan Zafar; Junhui Mi; Sarah Crook; Joyce Woo; Natalie Jayaram; Roosevelt Bryant 3rd; Tara Karamlou; James Tweddell; Kacie Dragan; Stephen Cook; Edward L Hannan; Jane W Newburger; Emile A Bacha; Robert Vincent; Khanh Nguyen; Kathleen Walsh-Spoonhower; Ralph Mosca; Neil Devejian; Steven A Kamenir; George M Alfieris; Michael F Swartz; David Meyer; Erin A Paul; John Billings; Brett R Anderson; New York State CHS-COLOUR

doi:10.1016/j.jacc.2021.11.036

Risk Stratification for Congenital Heart Surgery for ICD-10 Administrative Data (RACHS-2)

J Am Coll Cardiol. 2022 Feb 8;79(5):465-478. doi: 10.1016/j.jacc.2021.11.036.

Authors

Philip Allen¹, Farhan Zafar², Junhui Mi¹, Sarah Crook³, Joyce Woo⁴, Natalie Jayaram⁵, Roosevelt Bryant 3rd⁶, Tara Karamlou⁷, James Tweddell⁸, Kacie Dragan⁹, Stephen Cook¹⁰, Edward L Hannan¹¹, Jane W Newburger¹², Emile A Bacha¹³, Robert Vincent¹⁴, Khanh Nguyen¹⁵, Kathleen Walsh-Spoonhower¹⁶, Ralph Mosca¹⁷, Neil Devejian¹⁸, Steven A Kamenir¹⁹, George M Alfieris²⁰, Michael F Swartz²¹, David Meyer²², Erin A Paul²³, John Billings⁹, Brett R Anderson²⁴; New York State CHS-COLOUR

Affiliations

¹ Columbia University Mailman School of Public Health, New York, New York, USA.
² Division of Cardiac Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio, USA.
³ Division of Pediatric Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA.
⁴ Division of Pediatric Cardiology, Lurie Children's Hospital, Chicago, Illinois, USA. Electronic address: https://twitter.com/jwoomdms.
⁵ Division of Pediatric Cardiology, Children's Mercy Hospital, Kansas City, Missouri, USA.
⁶ Division of Cardiac Surgery, Phoenix Children's Hospital, Phoenix, Arizona, USA.
⁷ Department of Pediatric Cardiac Surgery and Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA. Electronic address: https://twitter.com/karamlou.
⁸ Division of Cardiac Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio, USA. Electronic address: https://twitter.com/jstweddell.
⁹ New York University Wagner Graduate School of Public Service, New York, New York, USA.
¹⁰ New York State Department of Health and Offices of Health Insurance Programs, Albany, New York, USA.
¹¹ University at Albany School of Public Health, Rensselaer, New York, USA.
¹² Department of Pediatric Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.
¹³ Department of Cardiothoracic Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center and Weill Cornell Medical Center, New York, New York, USA. Electronic address: https://twitter.com/emilebachamd.
¹⁴ Division of Pediatric Cardiology, Westchester Medical Center, Valhalla, New York, USA.
¹⁵ Department of Cardiac Surgery, Westchester Medical Center, Valhalla, New York, USA.
¹⁶ Division of Pediatric Cardiology, Stony Brook Children's Hospital, Stony Brook, New York, USA.
¹⁷ Division of Congenital Cardiothoracic Surgery, Hassenfeld Children's Hospital at NYU Langone Health, New York, New York, USA.
¹⁸ Division of Pediatric Cardiothoracic Surgery, Albany Medical College, Albany, New York, USA.
¹⁹ Division of Pediatric Cardiology, Albany Medical College, Albany, New York, USA.
²⁰ Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York, USA; Department of Surgery, State University of New York Upstate Medical Center, Syracuse, New York, USA.
²¹ Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York, USA.
²² Departments of Cardiothoracic Surgery and Pediatrics, Hofstra-Northwell School of Medicine, Hempstead, New York, USA.
²³ Division of Pediatric Cardiology, Ichan School of Medicine at Mount Sinai, New York, New York, USA.
²⁴ Division of Pediatric Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA. Electronic address: bra2113@cumc.columbia.edu.

Abstract

Background: As the cardiac community strives to improve outcomes, accurate methods of risk stratification are imperative. Since adoption of International Classification of Disease-10th Revision (ICD-10) in 2015, there is no published method for congenital heart surgery risk stratification for administrative data.

Objectives: This study sought 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 compared with 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% CI: 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% CI: 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 2 administrative-registry-linked datasets. Statistical code is publicly available upon request.

Keywords: CHS-COLOUR; ICD-10; New York Congenital Heart Surgeons Collaborative for Longitudinal Outcomes and Utilization of Resources; RACHS-1; RACHS-2; administrative data; congenital heart surgery; mortality; outcomes; risk adjustment; risk stratification.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Cardiac Surgical Procedures / methods*
Child
Databases, Factual
Female
Heart Defects, Congenital / classification*
Heart Defects, Congenital / epidemiology
Heart Defects, Congenital / surgery
Hospital Mortality / trends
Humans
Incidence
Infant
Male
ROC Curve
Registries*
Retrospective Studies
Risk Assessment / methods*

Abstract

Publication types

MeSH terms

Grants and funding