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

https://doi.org/10.1016/j.jacc.2021.11.036Get rights and content
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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.

Key Words

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

Abbreviations and Acronyms

AHRQ
Agency for Healthcare Research and Quality
CHS-COLOUR
New York Congenital Heart Surgeons Collaborative for Longitudinal Outcomes and Utilization of Resources
ICD
International Classification of Diseases
RACHS-1
Risk Adjustment for Congenital Heart Surgery
RACHS-2
Risk Stratification for Congenital Heart Surgery for ICD-10 Administrative Data
STAT Mortality Categories
Society of Thoracic Surgeons and the European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Categories
STS-CHS
Society of Thoracic Surgeons-Congenital Heart Surgery

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Listen to this manuscript's audio summary by Editor-in-Chief Dr Valentin Fuster on JACC.org.

Keila Lopez, MD, MPH, served as Guest Associate Editor for this paper.

Athena Poppas, MD, served as Guest Editor-in-Chief for this paper.

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