Abstract
Background: Development of a risk adjustment method is necessary to account for complexity of case mix in pediatric cardiac catheterization procedures so valid comparisons of outcomes can be determined.
Methods: Using a prospective database, we identified patient and procedural characteristics predictive of preventable serious or somewhat serious complications. Creation of 2 diagnosis groups and 5 procedural risk groups allowed classification according to the complexity of the diagnosis and anticipated relative risk of the procedure. Hemodynamic vulnerability was determined by baseline characteristics. Significant variables that increased the area under the receiver operator characteristic (ROC) curve were chosen for the final model. Expected complication rates and standardized complication ratios (SCR) were then determined for individual practitioners.
Results: Of 791 procedures, 26 (3.3%) had possibly or definitely preventable, serious or somewhat serious events. Event rates tended to increase as procedural risk category increased (0.5% in 1, 4.4% in 2, 4.2% in 3, 11.1% in 4, 8.0% in 5, p <0.001). Higher event rates were observed in younger patients (11.4% age < 1 month vs 2.9% 3 1 month, p<0.001) and those with physiologic vulnerability (4.7% vs 2.1%, p=0.04). These 3 factors remained independent predictors of higher event rate in multivariate analysis (area under ROC = 0.787). Among 7 cardiologists, significant case-mix differences were identified. Application of the risk adjustment yielded SCRs ranging from 0.5 to 1.7, and risk adjusted complication rates ranging from 1.6% to 5.6%. Although statistically significant differences in complication rates were not detected, there was a trend towards higher risk adjusted rates for less experienced interventionalists.
Conclusions: Further development and future validation of this risk adjustment method for pediatric cardiac catheterization will allow valid assessment of risk-adjusted performance of both practitioners and institutions performing these complex procedures.
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Bergersen, L., Nugent, A., Keane, J. et al. 34 Pediatric Interventional Catheterization: Development of a Risk Adjustment Model for Preventable Complications. Pediatr Res 58, 360 (2005). https://doi.org/10.1203/00006450-200508000-00063
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DOI: https://doi.org/10.1203/00006450-200508000-00063