The Journal of Thoracic and Cardiovascular Surgery
Congenital: Perioperative ManagementPrognostic utility of a novel risk prediction model of 1-year mortality in patients surviving to discharge after surgery for congenital or acquired heart disease
Graphical abstract
Section snippets
Patient Population
Data from patients who underwent surgery for congenital or acquired heart disease (the index operation) at a quaternary referral institution between January 1, 2011, and January 1, 2021, were retrospectively reviewed after Boston Children's Hospital Institutional Review Board approval and patient waiver of consent (Protocol Number: IRB-P00004706; date of approval: October 26, 2022). Operations (ie, cases) were included if the patients in question survived to discharge from the index
Results
Of 10,412 consecutive operations for congenital or acquired heart disease among 8510 unique patients during the study period, 8808 (84.6%) cases involving 7416 patients (87.1%) met entry criteria (Figure 1). A comparison of the analytic and excluded cohorts is shown in Table E2. Baseline patient-related and perioperative characteristics of the analytic cohort are summarized in Table 1. Of 8808 index operations, the median age at operation was 1.9 (IQR, 0.3-8.1) years, 923 (10.5%) cases were
Discussion
In this study, we formulated a novel risk prediction model of 1-year mortality for patients who underwent surgery for congenital or acquired heart disease and survived to discharge. This model comprised several preoperative and postoperative factors, including age, prematurity, noncardiac anomalies or syndromes, the COI, STAT mortality category, major adverse postoperative complications, and predischarge residual lesion severity (Figure 1). The variables in the final model that had the highest
Conclusions
A risk prediction model of 1-year mortality after discharge after congenital heart surgery, incorporating age, prematurity, noncardiac anomalies or syndromes, STAT mortality category, neighborhood SES, major adverse postoperative complications, and residual lesion severity, may guide follow-up and prognostication of patients with congenital or acquired heart disease.
References (33)
- et al.
Mortality trends in pediatric and congenital heart surgery: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database
Ann Thorac Surg
(2016) - et al.
An empirically based tool for analyzing mortality associated with congenital heart surgery
J Thorac Cardiovasc Surg
(2009) - et al.
The Society of Thoracic Surgeons Congenital Heart Surgery Database mortality risk model: part 1-statistical methodology
Ann Thorac Surg
(2015) - et al.
Consensus-based method for risk adjustment for surgery for congenital heart disease
J Thorac Cardiovasc Surg
(2002) - et al.
Galantowicz M, et al. Mortality prediction after cardiac surgery in children: an STS congenital heart surgery database analysis
Ann Thorac Surg
(2022) Lasso or BART: both miss the point
Ann Thorac Surg
(2022)- et al.
Congenital heart surgery program variable case mix: risk associated with adjusted mortality rate
Ann Thorac Surg
(2023) - et al.
The association of the Childhood Opportunity Index on pediatric readmissions and emergency department revisits
Acad Pediatr
(2022) - et al.
Impact of major residual lesions on outcomes after surgery for congenital heart disease
J Am Coll Cardiol
(2021) - et al.
Intraoperative residual lesion score predicts predischarge major residual lesions and reinterventions following congenital heart surgery
J Am Coll Cardiol
(2022)
Comparison of intraoperative and discharge residual lesion severity in congenital heart surgery
Ann Thorac Surg
Intraoperative technical performance score predicts outcomes after congenital cardiac surgery
Ann Thorac Surg
Long-term outcomes of patients requiring unplanned repeated interventions after surgery for congenital heart disease
J Am Coll Cardiol
Pediatric and congenital cardiovascular disease research challenges and opportunities: JACC review topic of the week
J Am Coll Cardiol
Trends in long-term mortality after congenital heart surgery
J Am Coll Cardiol
Estimating resource utilization in congenital heart surgery
Ann Thorac Surg
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This project was funded with internal departmental funds.
Institutional Review Board Protocol Number: IRB-P00004706; date of approval: October 26, 2022.
Patient waiver of consent was approved by Boston Children's Hospital Institutional Review Board.