ReviewThe Annals of thoracic surgery2019
Development of a Congenital Heart Surgery Composite Quality Metric: Part 2-Analytic Methods.
Review in The Annals of thoracic surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed.
- National Variation in Congenital Heart Surgery Outcomes.Circulation · 2020Trial
- Impact of Neighborhood and Individual Social Drivers of Health on Outcomes Following Congenital Heart Surgery.World journal for pediatric & congenital heart surgery · 2026Article
- Risk Models for Monitoring Postoperative Complication Rates After Paediatric Cardiac Surgery.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2025Article
- Risk of Cardiac Reoperation: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database.The Annals of thoracic surgery · 2024Article
- Association Between Past and Present Operative Mortality in Congenital Heart Surgery: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database.The Annals of thoracic surgery · 2024Article
- Textbook outcome for the Norwood operation-an informative quality metric in congenital heart surgery.JTCVS open · 2023Article
- Characterization of "ICU-30": A Binary Composite Outcome for Neonates With Critical Congenital Heart Disease.Journal of the American Heart Association · 2022Article
- Risk Stratification for Congenital Heart Surgery for ICD-10 Administrative Data (RACHS-2).Journal of the American College of Cardiology · 2022Article
- Comparison of Postoperative, In-Hospital Outcomes After Complete Repair of Tetralogy of Fallot Between 22q11.2 Deletion Syndrome and Trisomy 21.Pediatric cardiology · 2022Article
- Improvement in Pediatric Cardiac Surgical Outcomes Through Interhospital Collaboration.Journal of the American College of Cardiology · 2019Article
- The Quest for Precision Medicine: Unmeasured Patient Factors and Mortality After Congenital Heart Surgery.The Annals of thoracic surgery · 2019Article
- Development of a Congenital Heart Surgery Composite Quality Metric: Part 1-Conceptual Framework.The Annals of thoracic surgery · 2019Review
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Authors and funding
10 authors.
Funding
Abstract
backgroundWe describe the statistical methods and results related to development of the first congenital heart surgery composite quality measure.
methodsThe composite measure was developed using The Society of Thoracic Surgeons Congenital Heart Surgery Database (2012 to 2015), Bayesian hierarchical modeling, and the current Society of Thoracic Surgeons risk model for case-mix adjustment. It consists of a mortality domain (operative mortality) and morbidity domain (major complications and postoperative length of stay). We evaluated several potential weighting schemes and properties of the final composite measure, including reliability (signal-to-noise ratio) and hospital classification in various performance categories.
resultsOverall, 100 hospitals (78,425 operations) were included. Each adjusted metric included in the composite varied across hospitals: operative mortality (median, 3.1%; 10th to 90th percentile, 2.1% to 4.4%) major complications (median 11.7%, 10th to 90th percentile, 6.4% to 17.4%), and length of stay (median, 7.0 days; 10th to 90th percentile, 5.9 to 8.2 days). In the final composite weighting scheme selected, mortality had the greatest influence, followed by major complications and length of stay (correlation with overall composite score of 0.87, 0.69, and 0.47, respectively). Reliability of the composite measure was 0.73 compared with 0.59 for mortality alone. The distribution of hospitals across composite measure performance categories (defined by whether the 95% credible interval overlapped The Society of Thoracic Surgeons average) was 75% (same as expected), 9% (worse than expected), and 16% (better than expected).
conclusionsThis congenital heart surgery composite measure incorporates aspects of both morbidity and mortality, has clinical face validity, and greater ability to discriminate hospital performance compared with mortality alone. Ongoing efforts will support the use of the composite measure in benchmarking and quality improvement activities.
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