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Eur J Cardiothorac Surg 2005;28:877-881
© 2005 Elsevier Science NL

The RACHS-1 risk categories reflect mortality and length of stay in a Danish population of children operated for congenital heart disease

^a Department of Thoracic and Cardiovascular Surgery, Skejby Sygehus, Aarhus University Hospital, Brendstrupsvej, DK-8200 Aarhus N, Denmark
^b Department of Anaesthesiology and Intensive Care, Skejby Sygehus, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
^c Department of Clinical Epidemiology, Aarhus Hospital, Aarhus University Hospital, DK-8000 Aarhus C, Denmark

Received 2 March 2005; received in revised form 17 July 2005; accepted 6 September 2005.

^_* Corresponding author. Tel.: +45 89495416; fax: +45 89496005. (Email: vibeke.hjortdal{at}dadlnet.dk).

Objective: The Risk Adjusted classification for Congenital Heart Surgery (RACHS-1) was created in order to compare in-hospital mortality for groups of children undergoing surgery for congenital heart disease. The method was evaluated with two large multi-institutional data sets—the Paediatric Cardiac Care Consortium (PCCC) and Hospital Discharge (HD) data from three states in the USA. The RACHS-1 classification was later applied to a large German paediatric cardiac surgery population in Bad Oeynhausen (BO), where it was found that the RACHS-1 categories were also associated with length of stay. We applied the RACHS-1 classification to the 957 operations performed during January 1996 to December 2002 at Skejby Sygehus, Denmark and we examined the association between the RACHS-1 categories, in-hospital mortality and length of stay in the Intensive Care Unit. Methods: The operations were classified according to the six RACHS-1 categories by matching the procedure of each patient with a risk category. The ability of the RACHS-1 classification to predict mortality in our population was examined by estimating the area under the receiver operator characteristic (ROC) curve. Likelihood ratio ² tests were used to compare the distribution of RACHS-1 categories and the distribution of mortality with PCCC, HD and BO. Linear regression was used to examine the correlation between the RACHS-1 categories and length of stay in the Intensive Care Unit. Results: The RACHS-1 category frequencies in our population were: category 1: 18.4%, category 2: 37.4%, category 3: 34.6%, category 4: 8.2%, category 5: 0% and category 6: 1.5%. The overall ability of the RACHS-1 classification to predict in-hospital mortality (area under the ROC curve 0.741; 95% confidence interval = 0.690; 0.791) was equal to the findings from larger populations. We found no differences in the category specific mortality when comparing with the larger reported series. There was a positive association between RACHS-1 category and length of stay in the Intensive Care Unit. Conclusions: The RACHS-1 classification can also be used to predict in-hospital mortality and length of stay in the Intensive Care Unit in a small volume centre.

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

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