• 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, and Marshall Lewis Jacobs.
• Johns Hopkins All Children's Heart Institute, Saint Petersburg, Florida; Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: jeffjacobs@msn.com.
• Ann. Thorac. Surg. 2014 Nov 1;98(5):1653-8; discussion 1658-9.

BackgroundThe most common forms of risk adjustment for pediatric and congenital heart surgery used today are based mainly on the estimated risk of mortality of the primary procedure of the operation. The goals of this analysis were to assess the association of patient-specific preoperative factors with mortality and to determine which of these preoperative factors to include in future pediatric and congenital cardiac surgical risk models.MethodsAll index cardiac operations in The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) during 2010 through 2012 were eligible for inclusion. Patients weighing less than 2.5 kg undergoing patent ductus arteriosus closure were excluded. Centers with more than 10% missing data and patients with missing data for discharge mortality or other key variables were excluded. Rates of discharge mortality for patients with or without specific preoperative factors were assessed across age groups and were compared using Fisher's exact test.ResultsIn all, 25,476 operations were included (overall discharge mortality 3.7%, n=943). The prevalence of common preoperative factors and their associations with discharge mortality were determined. Associations of the following preoperative factors with discharge mortality were all highly significant (p<0.0001) for neonates, infants, and children: mechanical circulatory support, renal dysfunction, shock, and mechanical ventilation.ConclusionsCurrent STS-CHSD risk adjustment is based on estimated risk of mortality of the primary procedure of the operation as well as age, weight, and prematurity. The inclusion of additional patient-specific preoperative factors in risk models for pediatric and congenital cardiac surgery could lead to increased precision in predicting risk of operative mortality and comparison of observed to expected outcomes.Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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