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Eur J Cardiothorac Surg 2006;29:989-990
© 2006 Elsevier Science NL

Editorial comment

The goal is performance evaluation not outcome prediction

Denver Children's Hospital, University of Colorado, Denver, CO 80262, USA

^_* Corresponding author. Tel.: +1 303 8616624; fax: +1 303 7648022. (Email: lacour-gayet.francois@tchden.org).

The first 20% of the full text of this article appears below.

The article [1] from the Great Ormond Street (GOS) group raises a precise question: ‘Does the Aristotle Score Predict Outcome in Congenital Heart Surgery?’ The answer from the authors is ‘The Basic Aristotle score is only weakly associated with post-operative mortality in this GOS series.’ In fact, the Aristotle score showed a statistically significant correlation with mortality in their series with a p-value of 0.02 or 0.03. This seems acceptable for a score that was not created to predict mortality. The Aristotle Basic Score (ABS) was designed [2], based on a subjective approach, to define a constant called complexity, which is calculated as the sum of mortality, morbidity, and technical difficulty for 145 procedures in our specialty. Complexity, that we believe is a global constant for a given patient, serves as the basis to compare performance between centers or surgeons.

In contrast, the RACHS 1 was designed specifically to predict mortality as quoted in their initial article [3]. ‘The aim of RACHS . . . [Full Text of this Article]