Abstract
Objective. Objective assessment of results of treatment of children with congenital heart disease may be questionable.
This is due to the relatively low incidence of individual nosological forms and variety of methods of
their correction. The aim of this study is to present our first experience of Aristotle basic complexity (ABC)
score to evaluating quality in surgical treatment of pediatric patients with congenital heart defects.
Material and methods. Procedures performed in year 2004 and 2013 were analyzed. We estimated ABC score
by summing of three determinants: mortality, difficulty of postoperative period (“morbidity”) and anticipated
surgical technique difficultу. Proportion of procedures requiring at least 7 days of stay in the intensive care
unit was chosen as the marker of ”morbidity”. We calculated a threshold duration of cardiopulmonary bypass
(142 min) and used it as surrogate of surgical technical difficulty. Areas under the receiver-operating curve
(AUC) for ABC score were calculated and “cut-off” values were obtained. The ABC scores were correlated
to mortality, morbidity and technical difficulty. Patients having figures above 95% CI in all determinants were
considered to be potentially higher risk. ABS surgical performance was calculated. The quality of treatment
was evaluated by the performance index and compared it with data from leading foreign clinics.
Results. 1335 children with congenital heart defects undergone 1395 “open heart” procedures by one surgeon.
Early mortality was 5,7% (80/1395), 95% confidence interval (CI): 3.8–6.2%. Percent of early postoperative
complications 34.7% (485/1395), 95% confidence interval (CI): 32.1–37.3%. The mean ABC
score was 5.9±2.3 points. A high correlation was found between the ABC score and mortality, indices of
morbidity and technique difficulty. ABC score had a good performance of prediction for mortality, morbidity
and surgical technique difficultу. “Cut-off' value was 6,5 points. Group of patients with ABS score above
“cut-off” level had significantly higher probability of death (p=0.001). The high-risk patients were identified:
1 1/2 repair; double outlet right ventricle, Rastelli procedure; transposition of great arteries (TGA), redo
surgery; corrected TGA, palliative correction; common atrioventricular canal repair; pulmonary atresia with
ventricular septal defect repair; Norwood operation. ABC surgical performance over the past 5 years has
remained at the same level. The performance index was 0.56, the same indicators of foreign clinics ranged
from of 0.46 to 0.62.
Conclusion. ABC score is an effective and useful tool for treatment's quality assessment and high risk procedures
identification in patients with congenital heart defects.
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