Value of preoperative risk adjustment in congenital heart surgery (RACHS) score versus the vasoactive-ventilation-renal (VVR) score for predicting postoperative outcomes in neonates and children

Abstract

Objectives: To compare the post-cardiac surgery vasoactive-ventilation-renal (VVR) score with the preoperative risk adjustment in congenital heart surgery score (RACHS) for predicting postsurgical outcomes in neonates and children. Methods: This was an retrospective cohort study conducted at the King Abdulaziz Medical City, King Faisal Cardiac Center, tertiery hospital the section of the Pediatric Cardiac Intensive Care Unit (PCICU), Ministry of National Guard Health Affairs, that reviwed all surgical cases from Monday 1st January 2018 to Tuesday 31st of December 2019. InclusionOf all patients post operative cardic surgery. The outcomes for morbidity, mortality, length of stay, and ventilation length were then compared with the RACHS score. To determine the sensitivity and specificity of the VVR score, we tested it against outcomes such as ICU length of stay greater than 5 days and hospital length of stay greater than 7 days. The cutoff value was selected based on these outcomes. Spearman’s Rho correlation test was used to measure the strength of the association between the VVR and RACHS scores, the ROC analysis was done to generate Coordinates of the ROC Curve , cut of value and map the sensitivity and specifi. Data was analysied using SPSS and P valve of 0.05 was considered significant. Results: Out of 70 pateints identified we analyzed 68, 2 died during hospitalization. The files of neonates and children incleded ages of 0 to 14 years; 35,(51%) males, 33 (49%) females. The median age, weight, and height of 6.5 months, 4.55 kg, and 62 cm, respectively. Four patients had a RACHS of 1 or 2, while nine had a RACHS of 3 or 4 with a median of 2. Most cases required a bypass time of 93 minutes, IQR 68.3-119.5 (Table 2). The most common primary diagnosis was that of ventricular septal defects (36.8%), followed by a complete atrioventricular septal defect (13.2%), tetralogy of Fallot (7.4%), and D-transposition of great arteries with the intact ventricular septum (5.9%). There was a clear positive correlation between the VVR score and various parameters such as hospital LOS, ICU LOS, length of intubation, and RACHS at all times (0h, 12hr, 24hr, and 48hr). Moreover, all parameters was statistically significant when imputing VVR scores at different times with RACHS scores less than 3 and greater than or equal to 3 and hospital ICU stays longer than 5 days and hospital LOS > 7 days. Conclusion: There was a positive correlation between the RACHS and VVR scoring systems. In addition, the VVR postoperative cardiac score showed a significant correlation in predicting the severity of the disease postoperatively. These results suggest the validity of the VVR score for determining the prognosis, length of stay in the intensive care unit, ventilation days, and probable risk of mortality of pediatric patients undergoing different cardiac surgeries in the future.