Invited Commentary

Abstract

Congenital heart surgery is currently performed with an operative mortality of 4% or less at many if not most centers in developed countries. Evaluation of the quality of outcomes for survivors (96% plus) is becoming increasingly important. Every procedure has associated morbidity. It ranges from minor inconvenience to prolonged hospitalization with major complications, suffering, and permanent disability. Some would say that death is the ultimate morbidity. An important economic aspect of this issue is resource utilization produced by increased morbidity. The article by Bojan and colleagues [1Bojan M. Gerelli S. Gioanni S. Pouard P. Vouhé P. Evaluation of a new tool for morbidity assessment in congenital cardiac Surgery.Ann Thorac Surg. 2011; 92: 2200-2205Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar] compares the Aristotle Comprehensive Complexity Score (ACCS), the only rating system that includes morbidity, with actual outcomes previously suggested by our group. Both complications and resources used are applied to develop a morbidity index from a single institutional experience over 27 months. The correlation with ACCS was relatively high for all measurements examined. Because there was no incidence of renal failure requiring chronic dialysis, the correlation of the ACCS with the requirement for temporary dialysis was analyzed and found to be very high. It is suggested that this complication be included in the evaluation of morbidity. When ACCS was developed, the amount of available outcome data was limited. Therefore a group of congenital heart surgeons devised the scores using subjective probability, basically expert opinion. The goal moving forward is to revise the scores using actual outcome data. The mortality portion has been addressed at the procedure level [2O'Brien S.M. Clarke D.R. Jacobs J.P. et al.An empirically based tool for analyzing mortality associated with congenital heart surgery.J Thorac Cardiovasc Surg. 2009; 138: 1139-1153Abstract Full Text Full Text PDF PubMed Scopus (475) Google Scholar]. Hopefully the more difficult job of revising the morbidity portion will soon be accomplished. In the future, modification of the comprehensive score is desired so that individual patient factors are considered. This will require an enormous amount of data. In addition, as the specialty evolves further modifications will be needed. Perhaps software can be developed that will use The Society of Thoracic Surgeons/European Association for Cardio-Thoracic Surgery (STS/EACTS) databases to automatically update the scores as additional data are accumulated. Evaluation of a New Tool for Morbidity Assessment in Congenital Cardiac SurgeryThe Annals of Thoracic SurgeryVol. 92Issue 6PreviewTo date, no instrument to assess morbidity in congenital cardiac surgery has been validated. In the Aristotle system, morbidity is accounted for by a subjective assessment of length of intensive care unit stay. A previously published Morbidity Index (MI), still in development, has been derived from objective data. The present study aims to assess the feasibility and utility of the MI at a single institution and its association with the Aristotle Comprehensive Complexity (ACC) score. Full-Text PDF