The proposed risk scores and categories have a high degree of discrimination for predicting mortality and represent an improvement over existing consensus-based methods. Risk models incorporating these measures may be used to compare mortality outcomes across institutions with differing case mixes.

A complexity-adjusted method named the Aristotle Score, based on the complexity of the surgical procedures has been developed by an international group of experts. The Aristotle score, electronically available, was introduced in the EACTS and STS databases. A validation process evaluating its predictive value is being developed.

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Background We evaluated outcomes for common operations in the STS Congenital Heart Surgery Database (STS-CHSDB) to provide contemporary benchmarks and examine variation between centers. Methods Patients undergoing surgery from 2005-2009 were included. Centers with>10% missing data were excluded. Discharge mortality and postoperative length of stay (PLOS) among patients discharged alive were calculated for eight benchmark operations of varying complexity. Power for analyzing between-center variation in outcome was determined for each operation. Variation was evaluated using funnel plots and Bayesian hierarchical modeling. Results 18,375 index operations at 74 centers were included in the analysis of eight benchmark operations. Overall discharge mortality (range) was: ventricular septal defect repair (VSD) 0.6% (0%–5.1%), tetralogy of Fallot repair (TOF) 1.1% (0%–16.7%), complete atrioventricular canal repair (AVC) 2.2% (0%–20%), arterial switch (ASO) 2.9% (0%–50%), ASO+VSD 7.0% (0%–100%), Fontan 1.3% (0%–9.1%), truncus repair 10.9% (0%–100%), Norwood 19.3% (2.9%–100%). Funnel plots revealed the number of centers characterized as outliers were: VSD=0, TOF=0, AVC=1, ASO=3, ASO+VSD=1, Fontan=0, Truncus=4, Norwood=11. Power calculations showed statistically meaningful comparisons of mortality rates between centers could only be made for Norwood, for which the Bayesian-estimated range (95% Probability Interval) was 7.0% (3.7%-10.3%) to 41.6% (30.6%-57.2%). Between-center variation in PLOS was analyzed for all operations and was larger for more complex operations. Conclusions This analysis documents contemporary benchmarks for common pediatric cardiac surgical operations and the range of outcomes among centers. Variation was most prominent for the more complex operations. These data may aid in quality assessment and quality improvement initiatives.

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