Open Access

ARTICLE

Risk stratification models for congenital heart surgery in children: Comparative single‐center study

Sara Bobillo‐Perez^1,2, Joan Sanchez‐de‐Toledo^3,4, Susana Segura², Monica Girona‐Alarcon², Maria Mele⁵, Anna Sole‐Ribalta², Debora Cañizo Vazquez⁶, Iolanda Jordan^2,7, Francisco Jose Cambra^1,2
1 Disorders of Immunity and Respiration of the Pediatric Critical Patient Research Group, Institut Recerca Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
2 Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Spain
3 Pediatric Cardiology Department, Hospital Sant Joan de Déu, University of Barcelona, Spain
4 Department of Critical Care Medicine, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
5 Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
6 Neonatal Intensive Care Unit, Maternal, Fetal and Neonatology Center Barcelona (BCNatal), Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
7 Pediatric Infectious Diseases Research Group, Institut Recerca Hospital Sant Joan de Déu, CIBERESP, Barcelona, Spain
* Corresponding Author: Iolanda Jordan, Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Passeig Sant Joan de Déu, number 2, 08950 Esplugues de Llobregat, Barcelona, Spain. Email:

Congenital Heart Disease 2019, 14(6), 1066-1077. https://doi.org/10.1111/chd.12846

Abstract

Objective: Three scores have been proposed to stratify the risk of mortality for each cardiac surgical procedure: The RACHS‐1, the Aristotle Basic Complexity (ABC), and the STS‐EACTS complexity scoring model. The aim was to compare the ability to predict mortality and morbidity of the three scores applied to a specific population.
Design: Retrospective, descriptive study.
Setting: Pediatric and neonatal intensive care units in a referral hospital.
Patients: Children under 18 years admitted to the intensive care unit after surgery.
Interventions: None.
Outcome measures: Demographic, clinical, and surgical data were assessed. Morbidity was considered as prolonged length of stay (LOS > 75 percentile), high respiratory (>72 hours of mechanical ventilation), and high hemodynamic support (inotropic support >20).
Results: One thousand and thirty‐seven patients were included, in which 205 were newborns (18%). The category 2 was the most frequent in the three scores: In RACHS‐1, ABC, 44.9%, and STS‐EACTS, 40.8%. Newborns presented significant higher categories. Children required cardiopulmonary bypass in more occasions (P < .001) but the times of bypass and aortic cross‐clamp were significantly higher in newborns (P < .001 and P = .016). Thirty‐two patients died (2.8%). A quarter of pa‐ tients had a prolonged LOS, 17%, a high respiratory support, and 7.1%, a high hemo‐ dynamic support. RACHS‐1 (AUC 0.760) and STS‐EACTS (AUC 0.763) were more powerful for predicting mortality and STS‐EACTS for predicting prolonged LOS (AUC 0.733) and the need for high respiratory support (AUC 0.742).
Conclusions: STS‐EACTS seems to stratify better risk of mortality, prolonged LOS, and need for respiratory support after surgery.

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Keywords

cardiac surgery, congenital heart disease, hospital mortality, intensive care, morbidity, risk adjustment

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