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Risk Stratification Tool for Congenital Heart Surgery
Quick Takes
- While STAT categories are important tools for risk adjustment, there are practical considerations limiting their use outside of the local level.
- The RACHS-2 score as validated in this study is a publicly available tool for risk adjustment, which aligns with ICD-10 billing codes.
Study Questions:
Can an empirically derived, publicly available tool for Risk Stratification for Congenital Heart Surgery (RACHS-2) be developed for International Classification of Disease-10th Revision (ICD-10) administrative data?
Methods:
The RACHS-2 stratification system was refined in a training dataset of Pediatric Health Information Systems claims and compared with corresponding locally held Society of Thoracic Surgeons-Congenital Heart Surgery (STS-CHS) clinical registry data. The process was aimed at optimizing sensitivity and specificity of the new tool. New York State Medicaid claims were used as a second administrative data source for validation of the tool. Logistic regression was used to compare the ability of RACHS-2 to use administrative data to predict operative mortality versus STAT (STS-European Association for Cardio-Thoracic Surgery [EACTS] congenital heart surgery) 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, while C-statistics for models for operative mortality—adjusted for STAT Mortality Categories—in corresponding clinical registry data were 0.75 and 0.84.
Conclusions:
The authors concluded that RACHS-2 is a validated risk stratification system for pediatric cardiac surgery for ICD-10 administrative data.
Perspective:
The heterogeneity of cardiac surgical procedures for congenital heart surgery makes it challenging to risk adjust data for surgical outcomes. While the STAT Mortality Categories developed by STS and EACTS have become the preferred risk adjustment methodologies for congenital heart surgery, it is difficult to access these databases beyond the local level. The RACHS-2 risk stratification aligns cardiac procedures with the ICD-10 billing codes. The RACHS-2 score as validated in this study will allow for analysis of publicly available data to facilitate assessments of quality as well as enhance transparency in congenital heart surgery.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Prevention, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Interventions, CHD and Pediatrics and Prevention, CHD and Pediatrics and Quality Improvement, Interventions and Structural Heart Disease
Keywords: Cardiac Surgical Procedures, Health Information Systems, Heart Defects, Congenital, Information Storage and Retrieval, International Classification of Diseases, Pediatrics, Risk Adjustment, Risk Assessment, Secondary Prevention, Thoracic Surgery, Treatment Outcome
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