HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Boethig, D. Articles by Breymann, T. Search for Related Content PubMed PubMed Citation Articles by Boethig, D. Articles by Breymann, T. Related Collections Congenital - acyanotic Congenital - cyanotic

Eur J Cardiothorac Surg 2004;26:12-17
© 2004 Elsevier Science NL

The RACHS-1 risk categories reflect mortality and length of hospital stay in a large German pediatric cardiac surgery population

^a Department of Pediatric Cardiology and Intensive Care, Hannover Medical University, Hannover, Germany
^b Department of Cardiology, Children's Hospital, Boston, MA, USA
^c Department of Biometry, Hannover Medical University, Hannover, Germany
^d Pediatric Cardiology Practice, Hannover, Germany
^e Department of Thoracic, Cardiac and Vascular Surgery, Hannover Medical University, Hannover, Germany

Received 9 February 2004; accepted 29 March 2004.

^* Corresponding author. Department for Pediatric Cardiology and Intensive Care, Hannover Medical University, D-30625 Hannover, Carl-Neuberg-Strasse 1, Germany. Tel.: +49-511-523-9424; fax: +49-511-532-8419
e-mail: boethig{at}thg.mh-hannover.de

Objectives: The Risk Adjusted classification for Congenital Heart Surgery (RACHS-1) was published in January 2002, based on 4370 operations registered by the Pediatric Cardiac Care Consortium. It is designed for being easily applicable also for retrospective analysis of hospital discharge data sets; the classification was not developed for patients with heart transplantations, ventricular assist devices or patients above 18 years. We apply this classification to our 2368 correspondent procedures that were performed consecutively on 2223 patients between June 1996 and October 2002 in Bad Oeynhausen and analyze its relation to mortality and length of hospital stay. Methods: The procedures were grouped by the 6 RACHS-1 categories. Groping criteria were mainly the performed procedures; for few procedures age or diagnoses are needed in addition. The classification process itself took less than 10 working hours. Risk group frequencies in our/ the PCCC population were 1: 368/964 (15.5%/22.0%), 2: 831/1433 (35.1%/33.1%), 3: 744/1523 (31.4%/34.7%), 4: 284/276 (12.0%/6.3%), 5: 4/4 (0.2%/0.1%), 6: 137/168 (5.3%/3.8%). 18.8%/19.2% were under 1 month, 37.5%/31.6% 1–12 months of age, respectively. Results: Hospital mortality (%) in our population/ the PCCC Group 1–6 was: 0.3/0.4, 4.0/3.8, 5.6/8.5, 9.9/19.4, 50.0/0, 40.1/47.7%. Geometric means of total (13.1, 19.6, 23.5, 29.1, 31.5, 52.6 days, respectively) and postoperative length of stay of survivors show significant differences between the single risk groups. The prediction capacity of the score as expressed by the area under the receiver–operator curve was nearly equal to the value found for the American hospital discharge data sets. Length of stay rises exponentially with the RACHS-1 category. However, the RACHS-1 category explains only 13.5% of the total and 16.8% of individual postoperative lengths of hospital stay in survivors. Conclusion: The RACHS-1 classification is applicable to European pediatric populations, too. Category Distribution, outcome class distinction capacity, distribution and mortality are similar. RACHS-1 is able to classify patients into significantly different groups concerning total and postoperative hospital stay duration, although there remains a large variability within the groups.

Key Words: Congenital cardiac surgery • Scoring system • Mortality • Risk adjustment

This article has been cited by other articles:

				L. A. Larrazabal, K. J. Jenkins, K. Gauvreau, V. L. Vida, O. J. Benavidez, G. A. Gaitan, F. Garcia, and A. R. Castaneda Improvement in Congenital Heart Surgery in a Developing Country: The Guatemalan Experience Circulation, October 23, 2007; 116(17): 1882 - 1887. [Abstract] [Full Text] [PDF]

				L. Mildh, V. Pettila, H. Sairanen, and P. Rautiainen Predictive value of paediatric risk of mortality score and risk adjustment for congenital heart surgery score after paediatric open-heart surgery Interactive CardioVascular and Thoracic Surgery, October 1, 2007; 6(5): 628 - 631. [Abstract] [Full Text] [PDF]

				O. O. Al-Radi, F. E. Harrell Jr, C. A. Caldarone, B. W. McCrindle, J. P. Jacobs, M. G. Williams, G. S. Van Arsdell, and W. G. Williams Case complexity scores in congenital heart surgery: A comparative study of the Aristotle Basic Complexity score and the Risk Adjustment in Congenital Heart Surgery (RACHS-1) system J. Thorac. Cardiovasc. Surg., April 1, 2007; 133(4): 865 - 875. [Abstract] [Full Text] [PDF]

				K. F. Welke, I. Shen, and R. M. Ungerleider Current assessment of mortality rates in congenital cardiac surgery. Ann. Thorac. Surg., July 1, 2006; 82(1): 164 - 170. [Abstract] [Full Text] [PDF]

				S. H. Larsen, J. Pedersen, J. Jacobsen, S. P. Johnsen, O. K. Hansen, and V. Hjortdal The RACHS-1 risk categories reflect mortality and length of stay in a Danish population of children operated for congenital heart disease Eur. J. Cardiothorac. Surg., December 1, 2005; 28(6): 877 - 881. [Abstract] [Full Text] [PDF]