Key result
The Aristotle comprehensive complexity (ACC) score predicted in-hospital mortality better than ABC and RACHS-1 models, achieving an AUC of 0.704 (95% CI 0.64-0.76).
Why the study?
Does the ACC scoring system predict in-hospital mortality better than ABC and RACHS-1 models in pediatric patients undergoing congenital heart surgery?
Observational (n=1,150)
No
Does the ACC scoring system predict in-hospital mortality better than ABC and RACHS-1 models in pediatric patients undergoing congenital heart surgery?
Effect estimate: AUC 0.704 (95% CI 0.64-0.76)
The Aristotle comprehensive complexity (ACC) score is a better predictor of in-hospital mortality than ABC and RACHS-1 models for pediatric patients undergoing congenital heart surgery.
ACC may enhance mortality risk stratification in pediatric congenital heart surgery; leaves open prospective validation before changing practice or guidelines.
AIMS AND OBJECTIVES: To validate Aristotle basic complexity and Aristotle comprehensive complexity (ABC and ACC) and risk adjustment in congenital heart surgery-1 (RACHS-1) prediction models for in hospital mortality after surgery for congenital heart disease in a single surgical unit. MATERIALS AND METHODS: Patients younger than 18 years, who had undergone surgery for congenital heart diseases from July 2007 to July 2013 were enrolled. Scoring for ABC and ACC scoring and assigning to RACHS-1 categories were done retrospectively from retrieved case files. Discriminative power of scoring systems was assessed with area under curve (AUC) of receiver operating curves (ROC). Calibration (test for goodness of fit of the model) was measured with Hosmer-Lemeshow modification of χ2 test. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were applied to assess reclassification. RESULTS: A total of 1150 cases were assessed with an all-cause in-hospital mortality rate of 7.91%. When modeled for multivariate regression analysis, the ABC (χ2 = 8.24, P = 0.08), ACC (χ2 = 4.17 , P = 0.57) and RACHS-1 (χ2 = 2.13 , P = 0.14) scores showed good overall performance. The AUC was 0.677 with 95% confidence interval (CI) of 0.61-0.73 for ABC score, 0.704 (95% CI: 0.64-0.76) for ACC score and for RACHS-1 it was 0.607 (95%CI: 0.55-0.66). ACC had an improved predictability in comparison to RACHS-1 and ABC on analysis with NRI and IDI. CONCLUSIONS: ACC predicted mortality better than ABC and RCAHS-1 models. A national database will help in developing predictive models unique to our populations, till then, ACC scoring model can be used to analyze individual performances and compare with other institutes.
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Joshi et al. (2014) conducted an observational in congenital heart disease (n=1,150). Aristotle comprehensive complexity (ACC) score vs. Aristotle basic complexity (ABC) and RACHS-1 scores was evaluated on in-hospital mortality (AUC 0.704, 95% CI 0.64-0.76). The Aristotle comprehensive complexity (ACC) score predicted in-hospital mortality better than ABC and RACHS-1 models, achieving an AUC of 0.704 (95% CI 0.64-0.76).
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