Marshall L Jacobs1, Jeffrey P Jacobs2, Dylan Thibault3, Kevin D Hill4, Brett R Anderson5, Pirooz Eghtesady6, Tara Karamlou7, S Ram Kumar8, John E Mayer9, Carlos M Mery10, Meena Nathan9, David M Overman11, Sara K Pasquali12, James D St Louis13, David Shahian14, Sean M O'Brien3. 1. Department of Surgery, 1466Johns Hopkins University School of Medicine, Baltimore, MD, USA. 2. Department of Surgery, University of Florida, Gainesville, FL, USA. 3. Duke Clinical Research Institute, 12277Duke University School of Medicine, Durham, NC, USA. 4. Department of Pediatrics, 22957Duke University School of Medicine, Durham, NC, USA. 5. Division of Pediatric Cardiology, 21611Columbia University Irving Medical Center, New York, NY, USA. 6. Cardiothoracic Surgery, 12275Washington University in Saint Louis School of Medicine, St Louis, MO, USA. 7. Division of Pediatric Cardiac Surgery, Cleveland Clinic, Cleveland, OH, USA. 8. Department of Surgery, University of Southern California, Los Angeles, CA, USA. 9. Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, MA, USA. 10. Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, TX, USA. 11. Division of Cardiac Surgery, The Children's Heart Clinic, Children's Minnesota, Mayo Clinic-Children's Minnesota Cardiovascular Collaborative, Minneapolis, MN, USA. 12. Department of Pediatrics, University of Michigan 21634C.S. Mott Children's Hospital, Ann Arbor, MI, USA. 13. Department of Surgery and Pediatrics, Children's Hospital of Georgia, 1421Augusta University, Augusta, GA, USA. 14. Division of Cardiac Surgery, Department of Surgery, Center for Quality and Safety, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Abstract
OBJECTIVES: STAT Mortality Categories (developed 2009) stratify congenital heart surgery procedures into groups of increasing mortality risk to characterize case mix of congenital heart surgery providers. This update of the STAT Mortality Score and Categories is empirically based for all procedures and reflects contemporary outcomes. METHODS: Cardiovascular surgical operations in the Society of Thoracic Surgeons Congenital Heart Surgery Database (January 1, 2010 - June 30, 2017) were analyzed. In this STAT 2020 Update of the STAT Mortality Score and Categories, the risk associated with a specific combination of procedures was estimated under the assumption that risk is determined by the highest risk individual component procedure. Operations composed of multiple component procedures were eligible for unique STAT Scores when the statistically estimated mortality risk differed from that of the highest risk component procedure. Bayesian modeling accounted for small denominators. Risk estimates were rescaled to STAT 2020 Scores between 0.1 and 5.0. STAT 2020 Category assignment was designed to minimize within-category variation and maximize between-category variation. RESULTS: Among 161,351 operations at 110 centers (19,090 distinct procedure combinations), 235 types of single or multiple component operations received unique STAT 2020 Scores. Assignment to Categories resulted in the following distribution: STAT 2020 Category 1 includes 59 procedure codes with model-based estimated mortality 0.2% to 1.3%; Category 2 includes 73 procedure codes with mortality estimates 1.4% to 2.9%; Category 3 includes 46 procedure codes with mortality estimates 3.0% to 6.8%; Category 4 includes 37 procedure codes with mortality estimates 6.9% to 13.0%; and Category 5 includes 17 procedure codes with mortality estimates 13.5% to 38.7%. The number of procedure codes with empirically derived Scores has grown by 58% (235 in STAT 2020 vs 148 in STAT 2009). Of the 148 procedure codes with empirically derived Scores in 2009, approximately one-half have changed STAT Category relative to 2009 metrics. The New STAT 2020 Scores and Categories demonstrated good discrimination for predicting mortality in an independent validation sample (July 1, 2017-June 30, 2019; sample size 46,933 operations at 108 centers) with C-statistic = 0.791 for STAT 2020 Score and 0.779 for STAT 2020 Category. CONCLUSIONS: The updated STAT metrics reflect contemporary practice and outcomes. New empirically based STAT 2020 Scores and Category designations are assigned to a larger set of procedure codes, while accounting for risk associated with multiple component operations. Updating STAT metrics based on contemporary outcomes facilitates accurate assessment of case mix.
OBJECTIVES: STAT Mortality Categories (developed 2009) stratify congenital heart surgery procedures into groups of increasing mortality risk to characterize case mix of congenital heart surgery providers. This update of the STAT Mortality Score and Categories is empirically based for all procedures and reflects contemporary outcomes. METHODS: Cardiovascular surgical operations in the Society of Thoracic Surgeons Congenital Heart Surgery Database (January 1, 2010 - June 30, 2017) were analyzed. In this STAT 2020 Update of the STAT Mortality Score and Categories, the risk associated with a specific combination of procedures was estimated under the assumption that risk is determined by the highest risk individual component procedure. Operations composed of multiple component procedures were eligible for unique STAT Scores when the statistically estimated mortality risk differed from that of the highest risk component procedure. Bayesian modeling accounted for small denominators. Risk estimates were rescaled to STAT 2020 Scores between 0.1 and 5.0. STAT 2020 Category assignment was designed to minimize within-category variation and maximize between-category variation. RESULTS: Among 161,351 operations at 110 centers (19,090 distinct procedure combinations), 235 types of single or multiple component operations received unique STAT 2020 Scores. Assignment to Categories resulted in the following distribution: STAT 2020 Category 1 includes 59 procedure codes with model-based estimated mortality 0.2% to 1.3%; Category 2 includes 73 procedure codes with mortality estimates 1.4% to 2.9%; Category 3 includes 46 procedure codes with mortality estimates 3.0% to 6.8%; Category 4 includes 37 procedure codes with mortality estimates 6.9% to 13.0%; and Category 5 includes 17 procedure codes with mortality estimates 13.5% to 38.7%. The number of procedure codes with empirically derived Scores has grown by 58% (235 in STAT 2020 vs 148 in STAT 2009). Of the 148 procedure codes with empirically derived Scores in 2009, approximately one-half have changed STAT Category relative to 2009 metrics. The New STAT 2020 Scores and Categories demonstrated good discrimination for predicting mortality in an independent validation sample (July 1, 2017-June 30, 2019; sample size 46,933 operations at 108 centers) with C-statistic = 0.791 for STAT 2020 Score and 0.779 for STAT 2020 Category. CONCLUSIONS: The updated STAT metrics reflect contemporary practice and outcomes. New empirically based STAT 2020 Scores and Category designations are assigned to a larger set of procedure codes, while accounting for risk associated with multiple component operations. Updating STAT metrics based on contemporary outcomes facilitates accurate assessment of case mix.
Authors: Philip Allen; Farhan Zafar; Junhui Mi; Sarah Crook; Joyce Woo; Natalie Jayaram; Roosevelt Bryant; 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 Journal: J Am Coll Cardiol Date: 2022-02-08 Impact factor: 24.094