Philip Allen1, Farhan Zafar2, Junhui Mi1, Sarah Crook3, Joyce Woo4, Natalie Jayaram5, Roosevelt Bryant6, Tara Karamlou7, James Tweddell8, Kacie Dragan9, Stephen Cook10, Edward L Hannan11, Jane W Newburger12, Emile A Bacha13, Robert Vincent14, Khanh Nguyen15, Kathleen Walsh-Spoonhower16, Ralph Mosca17, Neil Devejian18, Steven A Kamenir19, George M Alfieris20, Michael F Swartz21, David Meyer22, Erin A Paul23, John Billings9, Brett R Anderson24. 1. Columbia University Mailman School of Public Health, New York, New York, USA. 2. Division of Cardiac Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio, USA. 3. Division of Pediatric Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA. 4. Division of Pediatric Cardiology, Lurie Children's Hospital, Chicago, Illinois, USA. Electronic address: https://twitter.com/jwoomdms. 5. Division of Pediatric Cardiology, Children's Mercy Hospital, Kansas City, Missouri, USA. 6. Division of Cardiac Surgery, Phoenix Children's Hospital, Phoenix, Arizona, USA. 7. Department of Pediatric Cardiac Surgery and Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA. Electronic address: https://twitter.com/karamlou. 8. Division of Cardiac Surgery, Cincinnati Children's Hospital, Cincinnati, Ohio, USA. Electronic address: https://twitter.com/jstweddell. 9. New York University Wagner Graduate School of Public Service, New York, New York, USA. 10. New York State Department of Health and Offices of Health Insurance Programs, Albany, New York, USA. 11. University at Albany School of Public Health, Rensselaer, New York, USA. 12. Department of Pediatric Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA. 13. Department of Cardiothoracic Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center and Weill Cornell Medical Center, New York, New York, USA. Electronic address: https://twitter.com/emilebachamd. 14. Division of Pediatric Cardiology, Westchester Medical Center, Valhalla, New York, USA. 15. Department of Cardiac Surgery, Westchester Medical Center, Valhalla, New York, USA. 16. Division of Pediatric Cardiology, Stony Brook Children's Hospital, Stony Brook, New York, USA. 17. Division of Congenital Cardiothoracic Surgery, Hassenfeld Children's Hospital at NYU Langone Health, New York, New York, USA. 18. Division of Pediatric Cardiothoracic Surgery, Albany Medical College, Albany, New York, USA. 19. Division of Pediatric Cardiology, Albany Medical College, Albany, New York, USA. 20. Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York, USA; Department of Surgery, State University of New York Upstate Medical Center, Syracuse, New York, USA. 21. Division of Cardiac Surgery, University of Rochester Medical Center, Rochester, New York, USA. 22. Departments of Cardiothoracic Surgery and Pediatrics, Hofstra-Northwell School of Medicine, Hempstead, New York, USA. 23. Division of Pediatric Cardiology, Ichan School of Medicine at Mount Sinai, New York, New York, USA. 24. Division of Pediatric Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA. Electronic address: bra2113@cumc.columbia.edu.
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.
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.
Authors: F Lacour-Gayet; D Clarke; J Jacobs; J Comas; S Daebritz; W Daenen; W Gaynor; L Hamilton; M Jacobs; B Maruszsewski; M Pozzi; T Spray; G Stellin; C Tchervenkov; C Mavroudis And Journal: Eur J Cardiothorac Surg Date: 2004-06 Impact factor: 4.191
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Authors: Tiffany J Riehle-Colarusso; Lisa Bergersen; Craig S Broberg; Cynthia H Cassell; Darryl T Gray; Scott D Grosse; Jeffrey P Jacobs; Marshall L Jacobs; Russell S Kirby; Lazaros Kochilas; Asha Krishnaswamy; Arianne Marelli; Sara K Pasquali; Thalia Wood; Matthew E Oster Journal: J Am Heart Assoc Date: 2016-10-26 Impact factor: 5.501
Authors: Brent McSharry; Lahn Straney; Janet Alexander; Tom Gentles; David Winlaw; John Beca; Johnny Millar; Frank Shann; Barry Wilkins; Andrew Numa; Christian Stocker; Simon Erickson; Anthony Slater Journal: J Am Heart Assoc Date: 2019-05-07 Impact factor: 5.501