STS develops surgical mortality risk model for adult congenital heart disease
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The Society of Thoracic Surgeons has developed a model of mortality risk for adults with congenital heart disease undergoing cardiac operations.
The model was presented at the STS Annual Meeting and published in The Annals of Thoracic Surgery.
“Adults living with congenital heart disease are one of the fastest-growing groups in need of cardiac surgery,” Jennifer S. Nelson, MD, MS, a pediatric cardiac surgeon at Nemours Children’s Hospital in Orlando, who presented the model, told Healio. “We realized that our understanding of the risks of cardiac surgery for these patients was rather limited. Earlier models that we had available were not customized for that patient population, and they don’t include many important risk factors such as congenital heart disease diagnoses and procedures. So there was an obvious opportunity for improvement.”
To develop the model, researchers used data from 192,196 patients with adult congenital heart disease identified in the STS Adult Cardiac Surgery Database who underwent cardiac surgery procedures between 2011 and 2019. The model was developed in 60% of the cohort and validated in the other 40%.
The outcome of interest was operative mortality, defined as all-cause death during the index hospitalization, even if for longer than 30 days or after transfer to an acute care facility and all-cause death after discharge if occurring before the end of the 30th day after the procedure.
After considering 72 variables specific to adult congenital heart disease, the researchers included 47 variables (18 diagnosis-related and 29 procedure-related) for inclusion in the model, along with 57 variables from the 2018 STS Adult Cardiac Surgery Database mortality models.
The model was well-calibrated within demographic, procedural and diagnosis subgroups, according to the researchers.
The model’s C statistic in the validation cohort was 0.815, superior to the C statistic of 0.79 for variables from the 2018 STS Adult Cardiac Surgery Database only (P < .0001), Nelson and colleagues found.
“We were happy to see that the model had excellent performance and that its predictive ability for operative mortality was significantly better than the other existing available adult risk models,” Nelson told Healio. “For the first time, we will have a better understanding of an adult congenital heart disease patient’s risk of dying following any type of cardiac surgery. Previous models are procedure-specific, so for patients not having one of those procedures, there was not a tool to help understand the risk of death after cardiac surgery. This metric is very important for preoperative counseling and it’s very helpful for institutions to be able to measure the quality of care that they are providing for these patients.”
The STS plans to develop an online risk calculator to implement the model in clinical practice, Nelson told Healio.
“This is similar to other STS risk models,” she said. “Ultimately, the adult congenital risk model may be used in quality reports that are issued to hospitals, but that change will take some time to implement.
“The way we capture data from adults with congenital heart disease is critical to improving this model moving forward,” she said. “The STS has introduced a new adult congenital data module, which is a new data collection form, which is designed to optimize the STS data registry for this population, and education of data managers and surgeons is ongoing.”
Reference:
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Nelson JS, et al. Plenary: J. Maxwell Chamberlain and James S. Tweddell Memorial Papers. Presented at: Society of Thoracic Surgeons Annual Meeting; Jan. 21-23, 2023; San Diego.
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