Impact of Surgical Complexity on Health‐Related Quality of Life in Congenital Heart Disease Surgical Survivors

Abstract

BackgroundSurgical complexity and related morbidities may affect long‐term patient quality of life (QOL). Aristotle Basic Complexity (ABC) score and Risk Adjustment in Congenital Heart Surgery (RACHS‐1) category stratify the complexity of pediatric cardiac operations. The purpose of this study was to examine the relationship between surgical complexity and QOL and to investigate other demographic and clinical variables that might explain variation in QOL in pediatric cardiac surgical survivors.Methods and ResultsPediatric Cardiac Quality of Life (PCQLI) study participants who had undergone cardiac surgery were included. The PCQLI database provided sample characteristics and QOL scores. Surgical complexity was defined by the highest ABC raw score or RACHS‐1 category. Relationships among surgical complexity and demographic, clinical, and QOL variables were assessed using ordinary least squares regression. A total of 1416 patient–parent pairs were included. Although higher ABC scores and RACHS‐1 categories were associated with lower QOL scores (P<0.005), correlation with QOL scores was poor to fair (r=−0.10 to −0.29) for all groups. Ordinary least squares regression showed weak association with R 2=0.06 to R 2=0.28. After accounting for single‐ventricle anatomy, number of doctor visits, and time since last hospitalization, surgical complexity scores added no additional explanation to the variance in QOL scores.Conclusions ABC scores and RACHS‐1 categories are useful tools for morbidity and mortality predictions prior to cardiac surgery and quality of care initiatives but are minimally helpful in predicting a child's or adolescent's long‐term QOL scores. Further studies are warranted to determine other predictors of QOL variation.

Impact of congenital heart surgery on quality of life in children and adolescents with surgically corrected Ventricular Septal Defect, Tetralogy of Fallot, and Transposition of the Great Arteries

“…Transposition of the Great Arteries and Ventricular Septal Defect correction normally requires only a single surgical intervention, whereas Tetralogy of Fallot often necessitates several surgical procedures and more hospitalisations. Interestingly, higher risk adjustment for congenital heart surgery categories was significantly associated with worse quality of life scores in paediatric cardiac patients, 30 which did not seem to be the case in the present study.…”

Machine learning in cardiovascular medicine: are we there yet?

“…These data are generally used to develop a model to predict or classify future events, or to find which variables are most relevant to the outcome. Examples of supervised learning algorithms include ordinary least squares regression,18 logistic regression,19 least absolute shrinkage and selection operator (LASSO) regression,20 ridge regression,21 elastic net regression,21 linear discriminant analysis,22 Naïve Bayes classifiers,9 support vector machines,23 Bayesian networks,24 a variety of decision trees25 especially Random Forests26 and AdaBoost or gradient boosting classifiers,27 artificial neural networks and ensemble methods 7. Some of the examples of supervised machine learning tasks include regression, classification, predictive modelling and survival analysis.…”

Health-related quality of life in pre-school age children with single-ventricle CHD

“…In contrast to our hypothesis and findings of other studies, healthrelated quality of life was comparable to children with biventricular forms of CHD. 2,5 Despite overall good health-related quality of life in children with mixed CHD at pre-school age, 6,11,12 children with singleventricle CHD seem to be at greatest risk for less favourable healthrelated quality of life. 2,[4][5][6] Goldberg et al reported on lower quality of life accompanied by poor functional status in single-ventricle CHD in comparison to healthy controls at 3 years of age.…”

“…2,5 Despite overall good health-related quality of life in children with mixed CHD at pre-school age, 6,11,12 children with singleventricle CHD seem to be at greatest risk for less favourable healthrelated quality of life. 2,[4][5][6] Goldberg et al reported on lower quality of life accompanied by poor functional status in single-ventricle CHD in comparison to healthy controls at 3 years of age. 9 An important difference to this particular study despite the comparison to healthy children, is the exclusion of children with genetic syndromes in our study, which are known to be at greatest risk for impaired quality of life and the comparison to healthy children.…”