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Croatian clinical epidemiological study (2008–2011): the use of standardised risk scores in paediatric congenital cardiac surgery for a case complexity selection and gradual progress of cardiosurgical model in developing countries

Published online by Cambridge University Press:  21 November 2013

Daniel Dilber*
Affiliation:
Department of Pediatrics, Division of Cardiology and Intensive Care Unit, University Hospital Zagreb, Zagreb, Croatia
Ivan Malčić
Affiliation:
Department of Pediatrics, Division of Cardiology and Intensive Care Unit, University Hospital Zagreb, Zagreb, Croatia
Andrea Dasović Buljević
Affiliation:
Department of Pediatrics, Division of Cardiology and Intensive Care Unit, University Hospital Zagreb, Zagreb, Croatia
Darko Anić
Affiliation:
Department of Cardiac Surgery, University Hospital Zagreb, Medical School of Zagreb, Zagreb, Croatia
Dražen Belina
Affiliation:
Department of Cardiac Surgery, University Hospital Zagreb, Medical School of Zagreb, Zagreb, Croatia
Ana Zovko
Affiliation:
Department of Pediatrics, Division of Cardiology and Intensive Care Unit, University Hospital Zagreb, Zagreb, Croatia
*
Correspondence to: Daniel Dilber, Department of Pediatrics, Division of Cardiology, University Hospital Zagreb, Medical School of Zagreb, Kispaticeva 12, Zagreb, Croatia. Tel: ++38512367589; Fax: 138512421894; E-mail: dilber_daniel@yahoo.com

Abstract

Objective: By employing the widely used and accepted methodologies of case-mix complexity adjustment in congenital cardiac surgery, we tried to evaluate our performance and use the ABC scores for a case complexity selection that may have different outcomes in various centres. Methods: We analysed outcomes of cardiac surgical procedures – with or without cardiopulmonary bypass – performed in our institution between January, 2008 and December, 2011. Data were collected from the European Association for Cardio-Thoracic Surgery database. Together with prospective collection of these data, the data of all patients sent abroad to foreign cardiosurgical centres were recorded. Results: During the period of study, 634 operations were performed; among them, 60% were performed in Croatia and 40% in foreign cardiosurgical centres. The number of operations performed in Croatia showed a linear increase: 55, 78, 121, and 126 operations performed in the years 2008, 2009, 2010, and 2011, respectively. Early mortality rates were 1.82%, 5.41%, 3.64%, and 3.48% in 2008, 2009, 2010, and 2011, respectively. The increase in the number of operations was followed by a satisfactory low average mortality rate of 3.85%. The mean ABC score complexity for operations performed in Croatia was 5.77. We determined a linear correlation between ABC score and early mortality, especially for the more complex operations. Conclusion: The use of standardised risk scores allows selection of complex cardiac diseases, which may have very different outcomes in various centres. In our case, those with higher ABC scores were correctly identified and referred for treatment abroad. In this way, we allowed gradual progress of the cardiosurgical model in Croatia and maintained an enviably low mortality rate.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2013 

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References

1. Jacobs, JP, Wernovsky, G, Elliott, MJ. Analysis of outcomes for congenital cardiac disease: can we do better? Cardiol Young 2007; 17: 145158.CrossRefGoogle ScholarPubMed
2. Jacobs, ML, Jacobs, JP, Franklin, RCG, et al. Databases for assessing the outcomes of the treatment of patients with congenital and paediatric cardiac disease – the perspective of cardiac surgery. Cardiol Young 2008; 18: 101115.Google Scholar
3. Tchervenkov, CI, Jacobs, JP, Bernier, PL, et al. The improvement of care for paediatric and congenital cardiac disease across the world: a challenge for the World Socitely for Pediatric and Congenital Heart Surgery. Cardiol Young 2008; 18: 6369.Google Scholar
4. Mavroudis, C, Jacobs, JP. Congenital heart disease outcome analysis: methodology and rationale. J Thorac Cardiovasc Surg 2002; 123: 67.CrossRefGoogle ScholarPubMed
5. Jacobs, JP, Mavroudis, C, Jacobs, ML, et al. Nomenclature and databases – the past, the present, and the future: a primer for the congenital heart surgeon. Pediatr Cardiol 2007; 28: 105115.CrossRefGoogle ScholarPubMed
6. Jacobs, JP, Jacobs, ML, Mavroudis, C, et al. Nomenclature and databases for the surgical treatment of congenital cardiac disease – an updated primer and an analysis of opportunities for improvement. Cardiol Young 2008; 18: 3862.CrossRefGoogle Scholar
7. Jenkins, KJ, Gauvreau, K, Newburger, JW, Spray, TL, Moller, JH, Iezzoni, LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123: 110118.Google Scholar
8. Lacour-Gayet, F, Clarke, D, Jacobs, J, et al. The Aristotle score: a complexity adjusted method to evaluate surgical results. Eur J Cardiothorac Surg 2004; 25: 911924.Google Scholar
9. Jacobs, ML, Jacobs, JP, Jenkins, KJ, Gauvreau, K, Clarke, DR, Lacour-Gayet, F. Stratification of complexity: the risk adjustment for congenital heart surgery-1 method and the Aristotle complexity score – past, present, and future. Cardiol Young 2008; 18: 163168.Google Scholar
10. Jacobs, JP, Jacobs, ML, Mavroudis, C, Lacour-Gayet, FG, Tchervenkov, CI. Executive summary: The Society of Thoracic Surgeons Congenital Heart Surgery Database – Sixth Harvest – (2002–2005). The Society of Thoracic Surgeons (STS) and Duke Clinical Research Institute (DCRI), Duke University Medical Center, Durham, North Carolina, United States, Spring 2006 Harvest.Google Scholar
11. O’Brien, SM, Jacobs, JP, Clarke, DR, et al. Accuracy of the Aristotle basic complexity score for classifying the mortality and morbidity potential of congenital heart surgery procedures. Ann Thorac Surg 2007; 84: 20272037.Google Scholar
12. Dilber, D, Malcic, I. Spectrum of congenital heart defects in Croatia. Eur J Pediatr 2010; 169: 543550.Google Scholar
13. Dilber, D, Malcic, I. Evaluation of paediatric cardiosurgical model in Croatia by using the Aristotle basic complexity score and the risk adjustment for congenital cardiac surgery-1 method. Cardiol Young 2010; 22: 18.Google Scholar
14. Bove, T, Francois, K, De Groote, K, et al. Outcome analysis of major cardiac operations in low weight neonates. Ann Thorac Surg 2004; 78: 181187.Google Scholar
15. Jenkins, KJ, Gauvreau, K. Center-specific differences in mortality: preliminary analyses using the risk adjustment in congenital heart surgery (RACHS-1) method. J Thorac Cardiovasc Surg 2002; 124: 97104.CrossRefGoogle ScholarPubMed
16. Jacobs, JP, O'Brien, SM, Pasquali, SK, et al. Variation in Outcomes for Benchmark Operations: an analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg 2011; 92: 21842192.CrossRefGoogle Scholar
17. Jacobs, JP, Jacobs, ML, Mavroudis, C, et al. Executive summary: The Society of Thoracic Surgeons Congenital Heart Surgery Database – Twelfth Harvest (January 1, 2006–December 31, 2009). The Society of Thoracic Surgeons (STS) and Duke Clinical Research Institute (DCRI), Duke University Medical Center, Durham, North Carolina, Spring 2010 Harvest.Google Scholar
18. Barach, PR, Jacobs, JP, Laussen, PC, Lipshultz, SE. Outcomes analysis, quality improvement, and patient safety for pediatric and congenital cardiac care: theory, implementation, and applications. Prog Pediatr Cardiol 2011; 32: 6567.Google Scholar
19. deLeval, MR, Carthey, J, Wright, DJ, Farewell, VT, Reason, JT. Human factors and cardiac surgery: a multi-center study. J Thorac Cardiovasc Surg 2000; 119: 551672.Google Scholar
20. Gauvreau, K. Reevaluation of the volume-outcome relationship for pediatric cardiac surgery. Circulation 2007; 115: 25992601.Google Scholar
21. Welke, KF, Diggs, BS, Karamlou, T, Ungerleider, RM. The relationship between hospital surgical case volumes and mortality rates in pediatric cardiac surgery: a national sample, 1988–2005. Ann Thorac Surg 2008; 86: 889896.CrossRefGoogle ScholarPubMed
22. Gawande, AA, Zinner, MJ, Studdert, DM, Brennan, TA. Analysis of errors by surgeons at three teaching hospitals. Surgery 2003; 133: 614621.CrossRefGoogle ScholarPubMed