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Databases for assessing the outcomes of the treatment of patients with congenital and paediatric cardiac disease – the perspective of cardiac surgery

Published online by Cambridge University Press:  01 December 2008

Marshall Lewis Jacobs*
Affiliation:
Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
Jeffrey Phillip Jacobs
Affiliation:
The Congenital Heart Institute of Florida (CHIF), Division of Thoracic and Cardiovascular Surgery, All Children’s Hospital and Children’s Hospital of Tampa, University of South Florida College of Medicine, Cardiac Surgical Associates (CSA), Saint Petersburg and Tampa, Florida, United States of America
Rodney C.G. Franklin
Affiliation:
Paediatric Cardiology Directorate, Royal Brompton & Harefield NHS Trust, Harefield, Middlesex, London, United Kingdom
Constantine Mavroudis
Affiliation:
Childrens Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
Francois Lacour-Gayet
Affiliation:
The Children’s Hospital, University of Colorado School of Medicine, Denver, Colorado, United States of America
Christo I. Tchervenkov
Affiliation:
Division of Pediatric Cardiovascular Surgery, The Montreal Children’s Hospital of the McGill University Health Centre, Montréal, Quebec, Canada
Hal Walters III
Affiliation:
Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan
Emile A. Bacha
Affiliation:
Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts, United States of America
David Robinson Clarke
Affiliation:
The Children’s Hospital, University of Colorado School of Medicine, Denver, Colorado, United States of America
J. William Gaynor
Affiliation:
Cardiac Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
Thomas L. Spray
Affiliation:
Cardiac Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
Giovanni Stellin
Affiliation:
Pediatric Cardiac Surgery Unit – University of Padova Medical School, Padova, Italy
Tjark Ebels
Affiliation:
Groningen University Medical Centre, Groningen, The Netherlands
Bohdan Maruszewski
Affiliation:
The Children’s Memorial Health Institute, Department of Cardiothoracic Surgery, Warsaw, Poland
Zdzislaw Tobota
Affiliation:
The Children’s Memorial Health Institute, Department of Cardiothoracic Surgery, Warsaw, Poland
Hiromi Kurosawa
Affiliation:
Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women’s Medical University, Tokyo, Japan
Martin Elliott
Affiliation:
Cardiac Unit, Great Ormond Street Hospital for Children, London, United Kingdom
*
Correspondence to: Marshall Lewis Jacobs, MD, 6019 Goshen Road, Newtown Square, Pennsylvania 19073, United States of America. Tel: 001-610 356 2615; Fax: 001-610 356 2880; E-mail: [email protected]

Abstract

This review includes a brief discussion, from the perspective of cardiac surgeons, of the rationale for creation and maintenance of multi-institutional databases of outcomes of congenital heart surgery, together with a history of the evolution of such databases, a description of the current state of the art, and a discussion of areas for improvement and future expansion of the concept. Five fundamental areas are reviewed: nomenclature, mechanism of data collection and storage, mechanisms for the evaluation and comparison of the complexity of operations and stratification of risk, mechanisms to ensure the completeness and accuracy of the data, and mechanisms for expansion of the current capabilities of databases to include comparison and sharing of data between medical subspecialties. This review briefly describes several European and North American initiatives related to databases for pediatric and congenital cardiac surgery the Congenital Database of The European Association for Cardio-Thoracic Surgery, the Congenital Database of The Society of Thoracic Surgeons, the Pediatric Cardiac Care Consortium, and the Central Cardiac Audit Database in the United Kingdom. Potential means of approaching the ultimate goal of acquisition of long-term follow-up data, and input of this data over the life of the patient, are also considered.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2008

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References

1.Kirklin, JW, Barratt-Boyes, BG. Cardiac Surgery. John Wiley & Sons, New York, NY, 1986.Google Scholar
2.Jacobs, JP, Ungerleider, RM, Tchervenkov, CI, et al. Opinions from the audience response survey at the First Joint Meeting of the Congenital Heart Surgeons’ Society and the European Congenital Heart Surgeons Association. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2005; 8: 198217.CrossRefGoogle Scholar
3.Trusler, GA, Castaneda, AR, Rosenthal, A, Blackstone, EH, Kirklin, JW. Current results of management in transposition of the great arteries, with special emphasis on patients with associated ventricular septal defect. J Am Coll Cardiol 1987; 10: 10611071.CrossRefGoogle ScholarPubMed
4.Castaneda, AR, Trusler, GA, Paul, MH, Blackstone, EH, Kirklin, JW. The early results of treatment of simple transposition in the current era. J Thorac Cardiovasc Surg 1988; 95: 1428.CrossRefGoogle ScholarPubMed
5.Williams, WG, McCrindle, BW. Practical experience with databases for congenital heart disease: a registry versus an academic database. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2002; 5: 132142.CrossRefGoogle ScholarPubMed
6. Mavroudis C (Chairman) and Congenital Database Subcommittee: Backer CL, Bove E, Burke RP, et al. Data Analyses of the Society of Thoracic Surgeons National Congenital Cardiac Surgery Database, 1994–1997, Summit Medical, Minnetonka, MN, September 1998.Google Scholar
7.Mavroudis, C, Gevitz, M, Rings, WS, McIntosh, CL, Schwartz, M. The Society of Thoracic Surgeons National Congenital Heart Surgery Database: analysis of the First Harvest (1994–1997). Ann Thorac Surg 1999; 68: 601624.CrossRefGoogle Scholar
8. Learning from Bristol: the report of the public inquiry into children’s heart surgery at the Bristol Royal Infirmary 1984–1995. Available at www.bristol-inquiry.org.uk. Accessed May 21, 2005.Google Scholar
9. Sherry A. Hospitals shield mortality rates. Denver Post March 1, 2001. www.denverpost.com/news/news0301b.htm, accessed March 21, 2001.Google Scholar
10. The Report of the Manitoba Pediatric Cardiac Surgery Inquest: An Inquest into twelve deaths at the Winnipeg Health Sciences Centre in 1994. www.pediatriccardiacinquest.mb.ca/, accessed May 21, 2005.Google Scholar
11.Williams, WG. Discussion of Jacobs JP, Lacour-Gayet FG, Jacobs ML, Clarke DR, Tchervenkov CI, Gaynor JW, Spray TL, Maruszewski B, Stellin G, Gould J, Dokholyan RS, Peterson EP, Elliott M, Mavroudis C. Initial application in the STS congenital database of complexity adjustment to evaluate surgical case mix and results. Ann Thorac Surg 2005; 79: 16351649.Google Scholar
12.Mavroudis, C, Jacobs, JP (eds). Congenital heart surgery nomenclature and database project. Ann Thorac Surg 2000; 69 (Suppl): S1S372.CrossRefGoogle ScholarPubMed
13.Franklin, RCG, Anderson, RH, Daniëls, O, et al. The European Paediatric Cardiac Code. Card Young 1999; 9: 633657.CrossRefGoogle Scholar
14.Béland, MJ, Franklin, RCG, Jacobs, JP, et al. Update from the International Working Group for Mapping and Coding of Nomenclature for Paediatric and Congenital Heart Disease. Cardiol Young 2004; 14: 225229.CrossRefGoogle Scholar
15.Maruszewski, B, Lacour-Gayet, F, Monro, JL, Keogh, BE, Tobota, Z, Kansy, A. An attempt at data verification in the EACTS Congenital Database. Eur J Cardiothorac Surg 2005; 28: 400404; discussion 405-6.CrossRefGoogle ScholarPubMed
16.Jacobs, ML, Mavroudis, C, Jacobs, JP, Tchervenkov, CI, Pelletier, GJ. Report of the 2005 STS Congenital Heart Surgery Practice and Manpower Survey: A Report from The STS Work Force on Congenital Heart Surgery. Ann Thorac Surg 2006; 82: 11521158, 1159e1-5; discussion 1158-9.CrossRefGoogle Scholar
17. Jacobs JP, Jacobs ML, Mavroudis C, Lacour-Gayet FG, Tchervenkov CI. Executive Summary: The Society of Thoracic Surgeons Congenital Heart Surgery Database – Eighth Harvest – (2004–2007). The Society of Thoracic Surgeons (STS) and Duke Clinical Research Institute (DCRI), Duke University Medical Center, Durham, North Carolina, United States, Spring 2008 Harvest.Google Scholar
18. Jacobs JP, Jacobs ML, Mavroudis C, Lacour-Gayet FG, Tchervenkov CI. Executive Summary: The Society of Thoracic Surgeons Congenital Heart Surgery Database – Seventh Harvest – (2003–2006). The Society of Thoracic Surgeons (STS) and Duke Clinical Research Institute (DCRI), Duke University Medical Center, Durham, North Carolina, United States, Spring 2007 Harvest.Google Scholar
19.Jacobs, JP, Mavroudis, C, Jacobs, ML, et al. Lessons learned from the data analysis of the Second Harvest (1998–2001) of The Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database. Eur J Cardiothorac Surg 2004; 26: 1837.CrossRefGoogle Scholar
20.Jacobs, JP, Lacour-Gayet, FG, Jacobs, ML, et al. Initial application in the STS congenital database of complexity adjustment to evaluate surgical case mix and results. Ann Thorac Surg 2005; 79: 16351649.CrossRefGoogle ScholarPubMed
21.Jacobs, JP, Jacobs, ML, Maruszewski, B, et al. Current status of the European Association for Cardio-Thoracic Surgery and the Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg 2005; 80: 22782283; discussion 2283-4.CrossRefGoogle Scholar
22.Moller, JH, Powell, CB, Joransen, JA, Borbas, C. The pediatric cardiac care consortium--revisited. Jt Comm J Qual Improv. 1994; 20: 661668.Google ScholarPubMed
24.Franklin, RCG, Anderson, RH, Daniëls, O, et al. The European Paediatric Cardiac Code: the first revision. Report of the Coding Committee of the Association for European Paediatric Cardiology. Cardiol Young 2002; 12: 611618.CrossRefGoogle Scholar
25.Clarke, DR, Breen, LS, Jacobs, ML, Franklin, RCG, Tobota, Z, Maruszewski, B. Data verification in congenital cardiac surgery. Cardiol Young 2008; 18 Suppl … (this supplement).Google ScholarPubMed
26. [http://www.ccad.org.uk/002/congenital.nsf/WMortality?Openview]. Accessed 9 February 2008 for Figure 11 (reproduced with permission).Google Scholar
27. [http://www.ccad.org.uk/002/congenital.nsf/0/16AFD27D0A18BD8D802573D3005CEE6D?OpenDocument?Benchmark]. Accessed 9 February 2008 for Figure 12 (reproduced with permission).Google Scholar
28.Gibbs, JL, Monro, JL, Cunningham, D, Rickards, A; Society of Cardiothoracic Surgeons of Great Britain and Northern Ireland; Paediatric Cardiac Association; Alder Hey Hospital (2004) Survival after surgery or therapeutic catheterization for congenital heart disease in children in the United Kingdom: analysis of the central cardiac audit database for 2001-1. BMJ 2004; 328: 611.CrossRefGoogle ScholarPubMed
29.Spiegelhalter, DJ. Funnel plots for comparing institutional performance. Stat Med 2005; 24: 11851202.CrossRefGoogle ScholarPubMed
30.Jenkins, KJ, Gauvreau, K, Newburger, JW, Spray, TL, Moller, JH, Iezzoni, LI. Consensus based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123: 110118.CrossRefGoogle ScholarPubMed
31.Jenkins, KJ. Risk adjustment for congenital heart surgery: The RACHS-1 method. Semin Thorac Cardiovasc Surg: Pediatr Card Surg Annu 2004; 7: 180184.CrossRefGoogle ScholarPubMed
32.Lacour-Gayet, FG, Clarke, D, Jacobs, JP, et al. and the Aristotle Committee. The Aristotle Score: a complexity-adjusted method to evaluate surgical results. Eur J Cardiothorac Surg 2004; 25: 911924.CrossRefGoogle Scholar
33.Lacour-Gayet, FG, Clarke, D, Jacobs, JP, et al. and the Aristotle Committee. The Aristotle score for congenital heart surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2004; 7: 185191.CrossRefGoogle ScholarPubMed
34.Jacobs, JP, Mavroudis, C, Jacobs, ML, et al. What is operative mortality? Defining death in a surgical registry database: a report from the STS Congenital Database Task Force and the Joint EACTS-STS Congenital Database Committee. Ann Thorac Surg 2006; 81: 19371941.CrossRefGoogle Scholar
35.Jacobs, JP, Jacobs, ML, Mavroudis, C, et al. What is operative morbidity? Defining complications in a surgical registry database: a report from the STS Congenital Database Task Force and the Joint EACTS-STS Congenital Database Committee. Ann Thorac Surg 2007; 84: 14161421.CrossRefGoogle Scholar
36.O’Brien, SM, Jacobs, JP, Clarke, DR, et al. Accuracy of the Aristotle basic complexity score for classifying the mortality and morbidity potential of congenital heart surgery operations. Ann Thorac Surg 2007; 84: 20272037.CrossRefGoogle ScholarPubMed