782 A Novel Method for Monitoring Risk-Adjusted Complications in Pediatric Cardiac Surgery

Abstract

BackgroundAs overall mortality rates have fallen in pediatric cardiac surgery, complication monitoring is becoming an increasingly important metric of patient outcome. Currently, there is no tool available to monitor severity-adjusted complications in congenital cardiac surgery.MethodsComplications associated with pediatric cardiac surgical procedures were prospectively collected on consecutive index procedures in a single pediatric cardiac surgical unit Oct 1,2009-Sept 31, 2011. Complications were accounted for by frequency and severity and then stratified by surgical complexity (using RACHS), giving an average morbidity burden per RACHS category. “Expected” morbidity burden for each RACHS category was derived from year 1 (2009-10) data. Observed minus expected (O:E) plots were then generated for the complications from year 2 (2010-11) data. Separate O:E plots were also created for five complication classes. These plots were then monitored for increases in frequency and/or severity of complications based on apriori limits.Results80 of 181 procedures (44%) were associated with complications. The frequency and severity of complications increased with surgical complexity. The O:E plot of all complications was flagged twice for increases in severity-adjusted complications. Using the class-specific O:E plots to dissect what the origin of the alarms were, the flags were found to originate from increased rates of infectious and cardiac/operative complications.ConclusionLe Alexander Endowment Award BackgroundAs overall mortality rates have fallen in pediatric cardiac surgery, complication monitoring is becoming an increasingly important metric of patient outcome. Currently, there is no tool available to monitor severity-adjusted complications in congenital cardiac surgery. As overall mortality rates have fallen in pediatric cardiac surgery, complication monitoring is becoming an increasingly important metric of patient outcome. Currently, there is no tool available to monitor severity-adjusted complications in congenital cardiac surgery. MethodsComplications associated with pediatric cardiac surgical procedures were prospectively collected on consecutive index procedures in a single pediatric cardiac surgical unit Oct 1,2009-Sept 31, 2011. Complications were accounted for by frequency and severity and then stratified by surgical complexity (using RACHS), giving an average morbidity burden per RACHS category. “Expected” morbidity burden for each RACHS category was derived from year 1 (2009-10) data. Observed minus expected (O:E) plots were then generated for the complications from year 2 (2010-11) data. Separate O:E plots were also created for five complication classes. These plots were then monitored for increases in frequency and/or severity of complications based on apriori limits. Complications associated with pediatric cardiac surgical procedures were prospectively collected on consecutive index procedures in a single pediatric cardiac surgical unit Oct 1,2009-Sept 31, 2011. Complications were accounted for by frequency and severity and then stratified by surgical complexity (using RACHS), giving an average morbidity burden per RACHS category. “Expected” morbidity burden for each RACHS category was derived from year 1 (2009-10) data. Observed minus expected (O:E) plots were then generated for the complications from year 2 (2010-11) data. Separate O:E plots were also created for five complication classes. These plots were then monitored for increases in frequency and/or severity of complications based on apriori limits. Results80 of 181 procedures (44%) were associated with complications. The frequency and severity of complications increased with surgical complexity. The O:E plot of all complications was flagged twice for increases in severity-adjusted complications. Using the class-specific O:E plots to dissect what the origin of the alarms were, the flags were found to originate from increased rates of infectious and cardiac/operative complications. 80 of 181 procedures (44%) were associated with complications. The frequency and severity of complications increased with surgical complexity. The O:E plot of all complications was flagged twice for increases in severity-adjusted complications. Using the class-specific O:E plots to dissect what the origin of the alarms were, the flags were found to originate from increased rates of infectious and cardiac/operative complications. ConclusionLe Alexander Endowment Award Le Alexander Endowment Award