Sean M O'Brien1, Jeffrey P Jacobs2, Sara K Pasquali3, J William Gaynor4, Tara Karamlou5, Karl F Welke6, Giovanni Filardo7, Jane M Han8, Sunghee Kim9, David M Shahian10, Marshall L Jacobs2. 1. Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina. Electronic address: sean.m.obrien@duke.edu. 2. Johns Hopkins All Children's Heart Institute, Saint Petersburg, Tampa, and Orlando, Florida; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Florida Hospital for Children, Orlando, Florida. 3. Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan. 4. Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 5. Division of Pediatric Cardiac Surgery, Benioff Children's Hospital, University of California, San Francisco, San Francisco, California. 6. Section of Congenital Cardiovascular Surgery, University of Illinois College of Medicine at Peoria, Children's Hospital of Illinois, Peoria, Illinois. 7. Institute for Health Care Research and Improvement, Baylor Health Care System, Dallas, Texas. 8. The Society of Thoracic Surgeons, Chicago, Illinois. 9. Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina. 10. Massachusetts General Hospital Department of Surgery and Center for Quality and Safety, and Harvard Medical School, Boston, Massachusetts.
Abstract
BACKGROUND: This study's objective was to develop a risk model incorporating procedure type and patient factors to be used for case-mix adjustment in the analysis of hospital-specific operative mortality rates after congenital cardiac operations. METHODS: Included were patients of all ages undergoing cardiac operations, with or without cardiopulmonary bypass, at centers participating in The Society of Thoracic Surgeons Congenital Heart Surgery Database during January 1, 2010, to December 31, 2013. Excluded were isolated patent ductus arteriosus closures in patients weighing less than or equal to 2.5 kg, centers with more than 10% missing data, and patients with missing data for key variables. Data from the first 3.5 years were used for model development, and data from the last 0.5 year were used for assessing model discrimination and calibration. Potential risk factors were proposed based on expert consensus and selected after empirically comparing a variety of modeling options. RESULTS: The study cohort included 52,224 patients from 86 centers with 1,931 deaths (3.7%). Covariates included in the model were primary procedure, age, weight, and 11 additional patient factors reflecting acuity status and comorbidities. The C statistic in the validation sample was 0.858. Plots of observed-vs-expected mortality rates revealed good calibration overall and within subgroups, except for a slight overestimation of risk in the highest decile of predicted risk. Removing patient preoperative factors from the model reduced the C statistic to 0.831 and affected the performance classification for 12 of 86 hospitals. CONCLUSIONS: The risk model is well suited to adjust for case mix in the analysis and reporting of hospital-specific mortality for congenital heart operations. Inclusion of patient factors added useful discriminatory power and reduced bias in the calculation of hospital-specific mortality metrics.
BACKGROUND: This study's objective was to develop a risk model incorporating procedure type and patient factors to be used for case-mix adjustment in the analysis of hospital-specific operative mortality rates after congenital cardiac operations. METHODS: Included were patients of all ages undergoing cardiac operations, with or without cardiopulmonary bypass, at centers participating in The Society of Thoracic Surgeons Congenital Heart Surgery Database during January 1, 2010, to December 31, 2013. Excluded were isolated patent ductus arteriosus closures in patients weighing less than or equal to 2.5 kg, centers with more than 10% missing data, and patients with missing data for key variables. Data from the first 3.5 years were used for model development, and data from the last 0.5 year were used for assessing model discrimination and calibration. Potential risk factors were proposed based on expert consensus and selected after empirically comparing a variety of modeling options. RESULTS: The study cohort included 52,224 patients from 86 centers with 1,931 deaths (3.7%). Covariates included in the model were primary procedure, age, weight, and 11 additional patient factors reflecting acuity status and comorbidities. The C statistic in the validation sample was 0.858. Plots of observed-vs-expected mortality rates revealed good calibration overall and within subgroups, except for a slight overestimation of risk in the highest decile of predicted risk. Removing patient preoperative factors from the model reduced the C statistic to 0.831 and affected the performance classification for 12 of 86 hospitals. CONCLUSIONS: The risk model is well suited to adjust for case mix in the analysis and reporting of hospital-specific mortality for congenital heart operations. Inclusion of patient factors added useful discriminatory power and reduced bias in the calculation of hospital-specific mortality metrics.
Authors: Jeffrey Phillip Jacobs; Constantine Mavroudis; Marshall Lewis Jacobs; Bohdan Maruszewski; Christo I Tchervenkov; François G Lacour-Gayet; David Robinson Clarke; Thomas Yeh; Henry L Walters; Hiromi Kurosawa; Giovanni Stellin; Tjark Ebels; Martin J Elliott Journal: Ann Thorac Surg Date: 2006-05 Impact factor: 4.330
Authors: Jeffrey Phillip Jacobs; Marshall Lewis Jacobs; Bohdan Maruszewski; Francois G Lacour-Gayet; Christo I Tchervenkov; Zdzislaw Tobota; Giovanni Stellin; Hiromi Kurosawa; Arata Murakami; J William Gaynor; Sara K Pasquali; David R Clarke; Erle H Austin; Constantine Mavroudis Journal: Eur J Cardiothorac Surg Date: 2012-06-14 Impact factor: 4.191
Authors: Rachel S Dokholyan; Lawrence H Muhlbaier; John M Falletta; Jeffrey P Jacobs; David Shahian; Constance K Haan; Eric D Peterson Journal: Am Heart J Date: 2009-06 Impact factor: 4.749
Authors: Jeffrey Phillip Jacobs; Sean M O'Brien; Sara K Pasquali; Sunghee Kim; J William Gaynor; Christo Ivanov Tchervenkov; Tara Karamlou; Karl F Welke; Francois Lacour-Gayet; Constantine Mavroudis; John E Mayer; Richard A Jonas; Fred H Edwards; Frederick L Grover; David M Shahian; Marshall Lewis Jacobs Journal: Ann Thorac Surg Date: 2014-09-26 Impact factor: 4.330
Authors: Jeffrey Phillip Jacobs; Sean M O'Brien; Sara K Pasquali; Marshall Lewis Jacobs; Francois G Lacour-Gayet; Christo I Tchervenkov; Erle H Austin; Christian Pizarro; Kamal K Pourmoghadam; Frank G Scholl; Karl F Welke; Constantine Mavroudis Journal: Ann Thorac Surg Date: 2011-12 Impact factor: 4.330
Authors: David M Overman; Jeffrey P Jacobs; Richard L Prager; Cameron D Wright; David R Clarke; Sara K Pasquali; Sean M O'Brien; Rachel S Dokholyan; Paul Meehan; Donna E McDonald; Marshall L Jacobs; Constantine Mavroudis; David M Shahian Journal: World J Pediatr Congenit Heart Surg Date: 2013-01
Authors: Sean M O'Brien; David R Clarke; Jeffrey P Jacobs; Marshall L Jacobs; Francois G Lacour-Gayet; Christian Pizarro; Karl F Welke; Bohdan Maruszewski; Zdzislaw Tobota; Weldon J Miller; Leslie Hamilton; Eric D Peterson; Constantine Mavroudis; Fred H Edwards Journal: J Thorac Cardiovasc Surg Date: 2009-11 Impact factor: 5.209
Authors: David M Shahian; Jeffrey P Jacobs; Fred H Edwards; J Matthew Brennan; Rachel S Dokholyan; Richard L Prager; Cameron D Wright; Eric D Peterson; Donna E McDonald; Frederick L Grover Journal: Heart Date: 2013-01-18 Impact factor: 5.994
Authors: David R Clarke; Linda S Breen; Marshall L Jacobs; Rodney C G Franklin; Zdzislaw Tobota; Bohdan Maruszewski; Jeffrey P Jacobs Journal: Cardiol Young Date: 2008-12 Impact factor: 1.093
Authors: Brett R Anderson; Amelia S Wallace; Kevin D Hill; Brian C Gulack; Roland Matsouaka; Jeffrey P Jacobs; Emile A Bacha; Sherry A Glied; Marshall L Jacobs Journal: Circ Cardiovasc Qual Outcomes Date: 2017-07
Authors: Dylan Thibault; Amelia S Wallace; Marshall L Jacobs; Christoph P Hornik; John M Costello; Gregory F Fleming; Jeffrey P Jacobs; Robert D B Jaquiss; Bryan H Goldstein; Reid C Chamberlain; Kevin D Hill Journal: Circ Cardiovasc Interv Date: 2019-06-04 Impact factor: 6.546
Authors: Devin M Parker; Allen D Everett; Meagan E Stabler; Luca Vricella; Marshall L Jacobs; Jeffrey P Jacobs; Heather Thiessen-Philbrook; Chirag R Parikh; Jeremiah R Brown Journal: J Card Surg Date: 2019-04-03 Impact factor: 1.620
Authors: Mike Saji; Walter J Hoyt; Gorav Ailawadi; Daniel P Mulloy; Ravi K Ghanta; Michael Ragosta; D Scott Lim Journal: Pediatr Cardiol Date: 2016-04-15 Impact factor: 1.655
Authors: Sara K Pasquali; Karen Chiswell; Matt Hall; Dylan Thibault; Jennifer C Romano; J William Gaynor; David M Shahian; Marshall L Jacobs; Michael G Gaies; Sean M O'Brien; Edward C Norton; Kevin D Hill; Patricia A Cowper; Nelangi M Pinto; Samir S Shah; John E Mayer; Jeffrey P Jacobs Journal: Ann Thorac Surg Date: 2020-02-24 Impact factor: 4.330
Authors: Devin M Parker; Allen D Everett; Meagan E Stabler; Luca Vricella; Marshall L Jacobs; Jeffrey P Jacobs; Chirag R Parikh; Sara K Pasquali; Jeremiah R Brown Journal: Ann Thorac Surg Date: 2019-07-16 Impact factor: 4.330
Authors: Sara K Pasquali; Michael Gaies; Mousumi Banerjee; Wenying Zhang; Janet Donohue; Mark Russell; J William Gaynor Journal: Ann Thorac Surg Date: 2019-08-06 Impact factor: 4.330
Authors: Michael P DiLorenzo; Ashley Santo; Jonathan J Rome; Huayan Zhang; Jennifer A Faerber; Laura Mercer-Rosa; Rachel K Hopper Journal: Semin Thorac Cardiovasc Surg Date: 2018-09-29
Authors: Sarah Tabbutt; Jennifer Schuette; Wenying Zhang; Jeffrey Alten; Janet Donohue; J William Gaynor; Nancy Ghanayem; Jeffrey Jacobs; Sara K Pasquali; Ravi Thiagarajan; Justin B Dimick; Mousumi Banerjee; David Cooper; Michael Gaies Journal: Pediatr Crit Care Med Date: 2019-02 Impact factor: 3.624
Authors: Sara K Pasquali; Amelia S Wallace; J William Gaynor; Marshall L Jacobs; Sean M O'Brien; Kevin D Hill; Michael G Gaies; Jennifer C Romano; David M Shahian; John E Mayer; Jeffrey P Jacobs Journal: Ann Thorac Surg Date: 2016-07-22 Impact factor: 4.330