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Naureckas Li C, Bonebrake A, Mansavage E, Moravec A, Schroeder SK. Advocating for Alignment in Pediatric Cardiothoracic Surgical Site Infection Surveillance Definitions. J Pediatric Infect Dis Soc 2024:piae044. [PMID: 38804856 DOI: 10.1093/jpids/piae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
Reporting definitions for Surgical Site Infections (SSIs) are frequently used to identify cases for quality improvement purposes. Here we highlight the discrepancies in reporting criteria for pediatric cardiac surgery procedures and call for alignment in definitions.
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Affiliation(s)
- Caitlin Naureckas Li
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
- Northwestern University Feinberg School of Medicine, Department of Pediatrics, Chicago, Illinois, USA
- Center for Quality and Safety, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | - Amanda Bonebrake
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | - Erica Mansavage
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | - Amy Moravec
- Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | - Sangeeta K Schroeder
- Northwestern University Feinberg School of Medicine, Department of Pediatrics, Chicago, Illinois, USA
- Center for Quality and Safety, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
- Division of Hospital-Based Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
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Jayaram N, Allen P, Hall M, Karamlou T, Woo J, Crook S, Anderson BR. Adjusting for Congenital Heart Surgery Risk Using Administrative Data. J Am Coll Cardiol 2023; 82:2212-2221. [PMID: 38030351 DOI: 10.1016/j.jacc.2023.09.826] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/11/2023] [Accepted: 09/26/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Congenital heart surgery (CHS) encompasses a heterogeneous population of patients and surgeries. Risk standardization models that adjust for patient and procedural characteristics can allow for collective study of these disparate patients and procedures. OBJECTIVES We sought to develop a risk-adjustment model for CHS using the newly developed Risk Stratification for Congenital Heart Surgery for ICD-10 Administrative Data (RACHS-2) methodology. METHODS Within the Kids' Inpatient Database 2019, we identified all CHSs that could be assigned a RACHS-2 score. Hierarchical logistic regression (clustered on hospital) was used to identify patient and procedural characteristics associated with in-hospital mortality. Model validation was performed using data from 24 State Inpatient Databases during 2017. RESULTS Of 5,902,538 total weighted hospital discharges in the Kids' Inpatient Database 2019, 22,310 pediatric cardiac surgeries were identified and assigned a RACHS-2 score. In-hospital mortality occurred in 543 (2.4%) of cases. Using only RACHS-2, the mortality mode had a C-statistic of 0.81 that improved to 0.83 with the addition of age. A final multivariable model inclusive of RACHS-2, age, payer, and presence of a complex chronic condition outside of congenital heart disease further improved model discrimination to 0.87 (P < 0.001). Discrimination in the validation cohort was also very good with a C-statistic of 0.83. CONCLUSIONS We created and validated a risk-adjustment model for CHS that accounts for patient and procedural characteristics associated with in-hospital mortality available in administrative data, including the newly developed RACHS-2. Our risk model will be critical for use in health services research and quality improvement initiatives.
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Affiliation(s)
| | - Philip Allen
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Matthew Hall
- Children's Hospital Association, Lenexa, Kansas, USA
| | | | - Joyce Woo
- Lurie Children's Hospital, Chicago, Illinois, USA
| | - Sarah Crook
- NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - Brett R Anderson
- NewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
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Mikulski MF, Well A, Subramanian S, Colman K, Fraser CD, Mery CM, Lion RP. Pericardial Effusions After the Arterial Switch Operation: A PHIS Database Review. World J Pediatr Congenit Heart Surg 2023; 14:148-154. [PMID: 36883788 PMCID: PMC10041572 DOI: 10.1177/21501351221146153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Background: Pericardial effusion (PCE) is a significant complication after pediatric cardiac surgery. This study investigates PCE development after the arterial switch operation (ASO) and its short-term and longitudinal impacts. Methods: A retrospective review of the Pediatric Health Information System database. Patients with dextro-transposition of the great arteries who underwent ASO from January 1, 2004, to March 31, 2022, were identified. Patients with and without PCE were analyzed with descriptive, univariate, and multivariable regression statistics. Results: There were 4896 patients identified with 300 (6.1%) diagnosed with PCE. Thirty-five (11.7%) with PCE underwent pericardiocentesis. There were no differences in background demographics or concomitant procedures between those who developed PCE and those who did not. Patients who developed PCE more frequently had acute renal failure (N = 56 (18.7%) vs N = 603(13.1%), P = .006), pleural effusions (N = 46 (15.3%) vs N = 441 (9.6%), P = .001), mechanical circulatory support (N = 26 (8.7%) vs N = 199 (4.3%), P < .001), and had longer postoperative length of stay (15 [11-24.5] vs 13 [IQR: 9-20] days). After adjustment for additional factors, pleural effusions (OR = 1.7 [95% CI: 1.2-2.4]), and mechanical circulatory support (OR = 1.81 [95% CI: 1.15-2.85]) conferred higher odds of PCE. There were 2298 total readmissions, of which 46 (2%) had PCE, with no difference in median readmission rate for patients diagnosed with PCE at index hospitalization (median 0 [IQR: 0-1] vs 0 [IQR: 0-0], P = .208). Conclusions: PCE occurred after 6.1% of ASO and was associated with pleural effusions and mechanical circulatory support. PCE is associated with morbidity and prolonged length of stay; however, there was no association with in-hospital mortality or readmissions.
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Affiliation(s)
- Matthew F Mikulski
- Department of Surgery and Perioperative Care, 377659Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, TX, USA
| | - Andrew Well
- Department of Surgery and Perioperative Care, 377659Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, TX, USA
| | - Sujata Subramanian
- Department of Surgery and Perioperative Care, 377659Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, TX, USA
| | - Kathleen Colman
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, TX, USA
- Department of Pediatrics, 377659Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Charles D Fraser
- Department of Surgery and Perioperative Care, 377659Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, TX, USA
| | - Carlos M Mery
- Department of Surgery and Perioperative Care, 377659Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, TX, USA
| | - Richard P Lion
- Texas Center for Pediatric and Congenital Heart Disease, UT Health Austin/Dell Children's Medical Center, Austin, TX, USA
- Department of Pediatrics, 377659Dell Medical School, The University of Texas at Austin, Austin, TX, USA
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Al-Radi OO. Commentary: What's in a name? The effect of misclassification in administrative data in the setting of congenital heart disease surgery. J Thorac Cardiovasc Surg 2021; 163:2241-2242. [PMID: 34865841 DOI: 10.1016/j.jtcvs.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Osman O Al-Radi
- Faculty of Medicine, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.
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Carrillo SA. Commentary: Goldilocks and the three bears. J Thorac Cardiovasc Surg 2021; 163:2240-2241. [PMID: 34799090 DOI: 10.1016/j.jtcvs.2021.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Sergio A Carrillo
- Department of Cardiothoracic Surgery, The Heart Center, Nationwide Children's Hospital and the Division of Cardiac Surgery, Department of Surgery, The Ohio State University, Columbus, Ohio.
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