Risk-stratified outcome of congenital heart surgery in Assiut University Hospital

Abstract

Context Assessment of surgical performance in the field of congenital heart surgery is very difficult, so many risk scoring systems have been developed. The most popular used systems nowadays are the risk adjustment for congenital heart surgery (RACHS-1) system, Aristotle basic complexity score (ABC score), and the Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery (STS-EACTS) mortality score and categories. Aims The aims of the study were the application of the three popular risk scoring systems to Assiut University Hospital for evaluation of the outcome results, determination of the correlations between the mortality and morbidity to the risk categories of these systems, comparison with other cardiac centers worldwide, and managing the factors that lead to different outcome in an attempt to improve our performance. Materials and methods A retrospective descriptive study including all pediatric patients (ages ranging from 0 to 16 years old, excluding preterm babies) who underwent cardiac surgery in Assiut University Hospital between January 2008 and December 2017 was conducted. Statistical analysis The receiver operating characteristic curve and univariate and multivariate analyses were performed with SPSS 16.0 for Windows. Results Postoperative in-hospital mortality was 5.8%, with increasing mortality rates at the higher levels of the RACHS-1 and the ABC. The mean ABC score was 5.57 ± 2.07, which represents a complexity between ABC levels 1 and 2. The mean STS-EACTS mortality score was 0.375 ± 0.376, which placed our complexity of procedures into categories 1–2. Conclusion The RACHS-1, ABC, and STS-EACTS mortality scoring systems are useful tools for assessing mortality discharge in a medium volume cardiac center in Egypt. These scores imply a procedural-based level of complexity in the institute, which would be useful information for a longitudinal study.