Congenital: Perioperative Management
Prognostic utility of a novel risk prediction model of 1-year mortality in patients surviving to discharge after surgery for congenital or acquired heart disease

Read at the 103rd Annual Meeting of The American Association for Thoracic Surgery, Los Angeles, California, May 6-9, 2023.
https://doi.org/10.1016/j.jtcvs.2023.04.032Get rights and content

Abstract

Objective

We sought to develop a novel risk prediction model of 1-year mortality after congenital heart surgery that accounts for clinical, anatomic, echocardiographic, and socioeconomic factors.

Methods

This was a single-center, retrospective review of consecutive index operations for congenital or acquired heart disease, from January 2011 to January 2021, among patients with known survival status at 1 year after discharge from the index hospitalization. The primary outcome was postdischarge mortality at 1 year. Variables of interest included age, prematurity, noncardiac anomalies or syndromes, the Childhood Opportunity Index, primary procedure, major adverse postoperative complications, and the Residual Lesion Score. Logistic regression was used to develop a weighted risk score for the primary outcome. Internal validation using a bootstrap-resampling approach was performed.

Results

Of 10,412 consecutive operations for congenital or acquired heart disease, 8808 (84.6%) cases met entry criteria, including survival to discharge. There were 190 (2.2%) deaths at 1 year postdischarge. A weighted risk score was formulated on the basis of the variables in the final risk prediction model, which included all aforementioned risk factors of interest. This model had a C-statistic of 0.82 (95% confidence interval, 0.80-0.85). The median risk score was 6 (interquartile range, 4-8) points. Patients were categorized as low (score 0-5), medium (score 6-10), high (score 11-15), or very high (score 16-20) risk. The expected probability of mortality was 0.4% ± 0.2%, 2.0% ± 1.1%, 10.1% ± 5.0%, and 36.6% ± 9.6% for low-risk, medium-risk, high-risk, and very high-risk patients, respectively.

Conclusions

A risk prediction model of 1-year mortality may guide prognostication and follow-up of patients after discharge after surgery for congenital or acquired heart disease.

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)

Cited by (2)

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.

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