Catheterization for Congenital Heart Disease Adjustment for Risk Method II

Author:

Quinn Brian P.1ORCID,Gunnelson Lauren C.1,Kotin Sarah G.1ORCID,Gauvreau Kimberlee1ORCID,Yeh Mary J.1ORCID,Hasan Babar2,Lozier John3ORCID,Barry Oliver M.4ORCID,Shahanavaz Shabana5ORCID,Batlivala Sarosh P.5ORCID,Salavitabar Arash6ORCID,Foerster Susan7ORCID,Goldstein Bryan8ORCID,Divekar Abhay9ORCID,Holzer Ralf10ORCID,Nicholson George T.11ORCID,O’Byrne Michael L.12ORCID,Whiteside Wendy13ORCID,Bergersen Lisa1

Affiliation:

1. Department of Cardiology, Boston Children’s Hospital, MA (B.P.Q., L.C.G., S.G.K., K.G., M.J.Y., L.B.).

2. Division of Cardio-Thoracic Sciences, Sindh Institute of Urology and Transplantation, Pakistan (B.H.).

3. Division of Pediatric Cardiology, UH Rainbow Babies and Children’s Hospital, Cleveland, OH (J.L.).

4. Division of Pediatric Cardiology, Columbia University Medical Center, New York Presbyterian/Morgan Stanley Children’s Hospital (O.M.B.).

5. Cincinnati Children’s Hospital–Heart Institute and Department of Pediatrics, University of Cincinnati College of Medicine, OH (S.S., S.P.B.).

6. The Heart Center, Nationwide Children’s Hospital, Columbus, OH (A.S.).

7. Division of Pediatric Cardiology, Children’s Wisconsin, Milwaukee (S.F.).

8. Heart Institute, UPMC Children’s Hospital of Pittsburgh and Department of Pediatrics, University of Pittsburgh School of Medicine, PA (B.G.).

9. Division of Pediatric Cardiology, UT Southwestern Medical Center, Children’s Medical Center Dallas, TX (A.D.).

10. Division of Pediatric Cardiology, Department of Pediatrics, University of California Davis, Sacramento (R.H.).

11. Division of Pediatric Cardiology, Monroe Carell Jr. Children’s Hospital at Vanderbilt University Medical Center, Nashville, TN (G.T.N.).

12. Division of Cardiology, Children’s Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (M.L.O.).

13. Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor (W.W.).

Abstract

BACKGROUND: Current metrics used to adjust for case mix complexity in congenital cardiac catheterization are becoming outdated due to the introduction of novel procedures, innovative technologies, and expanding patient subgroups. This study aims to develop a risk adjustment methodology introducing a novel, clinically meaningful adverse event outcome and incorporating a modern understanding of risk. METHODS: Data from diagnostic only and interventional cases with defined case types were collected for patients ≤18 years of age and ≥2.5 kg at all Congenital Cardiac Catheterization Project on Outcomes participating centers. The derivation data set consisted of cases performed from 2014 to 2017, and the validation data set consisted of cases performed from 2019 to 2020. Severity level 3 adverse events were stratified into 3 tiers by clinical impact (3a/b/c); the study outcome was clinically meaningful adverse events, severity level ≥3b (3bc/4/5). RESULTS: The derivation data set contained 15 224 cases, and the validation data set included 9462 cases. Clinically meaningful adverse event rates were 4.5% and 4.2% in the derivation and validation cohorts, respectively. The final risk adjustment model included age <30 days, Procedural Risk in Congenital Cardiac Catheterization risk category, and hemodynamic vulnerability score (C statistic, 0.70; Hosmer-Lemeshow P value, 0.83; Brier score, 0.042). CONCLUSIONS: CHARM II (Congenital Heart Disease Adjustment for Risk Method II) risk adjustment methodology allows for equitable comparison of clinically meaningful adverse events among institutions and operators with varying patient populations and case mix complexity performing pediatric cardiac catheterization.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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