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Advances in Pediatrics

Evaluation of the Quality of Care in Congenital Heart Surgery: Contribution of the Aristotle Complexity Score

      It is only in the last decade that surgeons, particularly cardiac surgeons, became aware that the evaluation of quality of care is a fundamental aspect of their practice. Even today, the most read reports about the quality of care in hospitals or departments are produced by media, insurance companies, or institutions trying to define centers of excellence. Under the auspices of the Society of Thoracic Surgeons (STS) in North America and the European Association of Cardio–Thoracic Surgery (EACTS) in Europe, a strong international movement was initiated by cardiac surgeons to place the evaluation of quality of care under the governance of the health care delivery team [
      • Mavroudis C.
      • Jacobs J.P.
      International Congenital Heart Surgery Nomenclature and Database Project.
      ,
      • Lacour-Gayet F.
      • Maruszewski B.
      • Mavroudis C.
      • et al.
      Presentation of the International Nomenclature for Congenital Heart Surgery. The long way from nomenclature to collection of validated data at the EACTS.
      ,
      • Lacour-Gayet F.
      Risk stratification theme for congenital heart surgery.
      ,
      • Lacour-Gayet F.
      • Clarke D.
      • Jacobs J.
      • et al.
      The Aristotle score for congenital heart surgery.
      ,
      • Lacour-Gayet F.
      • Clarke D.
      • Jacobs J.
      • et al.
      The Aristotle Committee
      The Aristotle score: a complexity-adjusted method to evaluate surgical results.
      ,
      • Jacobs J.P.
      • Mavroudis C.
      • Jacobs M.L.
      • 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.
      ,
      • Jacobs J.P.
      • Maruszewski B.
      • Tchervenkov C.I.
      • et al.
      The current status and future directions of efforts to create a global database for the outcomes of therapy for congenital heart disease.
      ,
      • Jacobs J.P.
      • Lacour-Gayet F.G.
      • Jacobs M.L.
      • et al.
      Initial application in the STS congenital database of complexity adjustment to evaluate surgical case mix and results.
      ,
      • Lacour-Gayet F.
      • Clarke D.R.
      Aristotle Committee
      The Aristotle method: a new concept to evaluate quality of care based on complexity.
      ,
      • Jacobs J.P.
      • Maruszewski B.
      European Association for Cardio–thoracic Surgery–Society of Thoracic Surgeons Joint Congenital Heart Surgery Nomenclature and Database Committee
      Computerized outcomes analysis for congenital heart disease.
      ,
      • Jacobs J.P.
      • Jacobs M.L.
      • Maruszewski B.
      • et al.
      Current status of the European Association for Cardio–Thoracic Surgery and the Society of Thoracic Surgeons Congenital Heart Surgery Database.
      ,
      • Jacobs J.P.
      • Mavroudis C.
      • Jacobs M.L.
      • et al.
      What is operative mortality? Defining death in a surgical registry database: a report of the STS Congenital Database Taskforce and the Joint EACTS-STS Congenital Database Committee.
      ]. Initially considered a research issue, the evaluation of quality of care today must answer a legitimate growing demand from patients, families, hospital managers, referring physicians, insurance companies, government agencies, courts, and the media. A rapid shift in the mentality of many surgeons has occurred. In the past, the quality evaluation process was perceived by most surgeons as an unpleasant questioning of one's practice. Today, for a rapidly increasing number of cardiac surgeons, quality evaluation has become a legitimate scientific necessity. Evaluation of quality of care is a new chapter of modern medicine, which follows a different rhetoric and demands the need to measure and compare. “One cannot evaluate what is not measured” is a classical statement of business management. Many instruments used in the past to describe results are now obsolete. New methods, parameters, and vocabulary are needed to measure quality of care. A new mentality is emerging; it is a climate of self-evaluation of quality of care driven by scientific methods.
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      References

        • Mavroudis C.
        • Jacobs J.P.
        International Congenital Heart Surgery Nomenclature and Database Project.
        Ann Thorac Surg. 2000; 69: 1-372
        • Lacour-Gayet F.
        • Maruszewski B.
        • Mavroudis C.
        • et al.
        Presentation of the International Nomenclature for Congenital Heart Surgery. The long way from nomenclature to collection of validated data at the EACTS.
        Eur J Cardiothorac Surg. 2000; 18: 128-135
        • Lacour-Gayet F.
        Risk stratification theme for congenital heart surgery.
        Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2002; 5: 148-152
        • Lacour-Gayet F.
        • Clarke D.
        • Jacobs J.
        • et al.
        The Aristotle score for congenital heart surgery.
        Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2004; 7: 185-191
        • Lacour-Gayet F.
        • Clarke D.
        • Jacobs J.
        • et al.
        • The Aristotle Committee
        The Aristotle score: a complexity-adjusted method to evaluate surgical results.
        Eur J Cardiothorac Surg. 2004; 25: 911-924
        • Jacobs J.P.
        • Mavroudis C.
        • Jacobs M.L.
        • 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: 18-37
        • Jacobs J.P.
        • Maruszewski B.
        • Tchervenkov C.I.
        • et al.
        The current status and future directions of efforts to create a global database for the outcomes of therapy for congenital heart disease.
        Cardiol Young. 2005; 15: 190-197
        • Jacobs J.P.
        • Lacour-Gayet F.G.
        • Jacobs M.L.
        • et al.
        Initial application in the STS congenital database of complexity adjustment to evaluate surgical case mix and results.
        Ann Thorac Surg. 2005; 79: 1635-1649
        • Lacour-Gayet F.
        • Clarke D.R.
        • Aristotle Committee
        The Aristotle method: a new concept to evaluate quality of care based on complexity.
        Curr Opin Pediatr. 2005; 17: 412-417
        • Jacobs J.P.
        • Maruszewski B.
        • European Association for Cardio–thoracic Surgery–Society of Thoracic Surgeons Joint Congenital Heart Surgery Nomenclature and Database Committee
        Computerized outcomes analysis for congenital heart disease.
        Curr Opin Pediatr. 2005; 17: 586-591
        • Jacobs J.P.
        • Jacobs M.L.
        • 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: 2278-2284
        • Jacobs J.P.
        • Mavroudis C.
        • Jacobs M.L.
        • et al.
        What is operative mortality? Defining death in a surgical registry database: a report of the STS Congenital Database Taskforce and the Joint EACTS-STS Congenital Database Committee.
        Ann Thorac Surg. 2006; 81: 1937-1941
      1. Strickland MJ, Riehle-Colarusso TJ, Reller MD, et al. The utility of administrative databases for congenital heart surgery outcomes analysis. Submitted for publication.

      2. Jacobs JP, Jacobs ML, Mavroudis C, et al. Executive summary: the Society of Thoracic Surgeons Congenital Heart Surgery Database—Sixth Harvest (2002–2005). The Society of Thoracic Surgeons (STS) and Duke Clinical Research Institute (DCRI), Duke University Medical Center, Durham, North Carolina, United States, Spring 2006 Harvest. Available at: www.sts.org. Accessed June 1, 2007.

        • Jenkins K.J.
        • Gauvreau K.
        • Newburger J.W.
        • et al.
        Consensus-based method for risk adjustment for surgery for congenital heart disease.
        J Thorac Cardiovasc Surg. 2002; 123: 110-118
        • Williams W.G.
        • McCrindle B.W.
        Practical experience with databases for congenital heart disease: a registry versus an academic database.
        Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2002; 5: 132-142
      3. Jacobs H, Mavroudis C, Jacobs JP. The CardioAccess Congenital Cardiac Minimum Database. Available at: http://www.cardioaccess.com/. Accessed June 1, 2007.

        • Elfstrom J.
        • Stubberod A.
        • Troeng T.
        Patients not included in medical audit have a worse outcome than those included.
        Int J Qual Health Care. 1996; 8: 153-157
        • Gibbs J.L.
        • Monro J.L.
        • Cunningham D.
        • et al.
        Survival after surgery or therapeutic catheterisation for congenital heart disease in children in the United Kingdom: analysis of the central cardiac audit database for 2000–1.
        BMJ. 2004; 328: 611-616
        • Bohdan Maruszewski
        • Lacour-Gayet F.
        • Monro J.L.
        • et al.
        An attempt at data verification in the EACTS Congenital Database.
        Eur J Cardiothorac Surg. 2005; 28: 400-404
        • Blackstone E.H.
        • Kirklin J.W.
        Death and other time-related events after valve replacement.
        Circulation. 1985; 72: 753-767
        • de Leval M.R.
        • Francois K.
        • Bull C.
        • et al.
        Analysis of a cluster of surgical failures. Application to a series of neonatal arterial switch operations.
        J Thorac Cardiovasc Surg. 1994; 107 ([discussion: 923–4]): 914-923
        • Zobel G.
        • Rodl S.
        • Rigler B.
        • et al.
        Prospective evaluation of clinical scoring systems in infants and children with cardiopulmonary insufficiency after cardiac surgery.
        J Cardiovasc Surg (Torino). 1993; 34: 333-337
        • Miyamoto T.
        • Sinzobahamvya N.
        • Kumpikaite D.
        • et al.
        Repair of truncus arteriosus and aortic arch interruption: outcome analysis.
        Ann Thorac Surg. 2005; 79: 2077-2082
        • Netz B.C.
        • Hoffmeier A.
        • Krasemann T.
        • et al.
        Related articles, links low weight in congenital heart surgery: is it the right way?.
        Thorac Cardiovasc Surg. 2005; 53: 330-333
        • Sinzobahamvya N.
        • Photiadis J.
        • Kumpikaite D.
        • et al.
        Comprehensive Aristotle score: implications for the Norwood procedure.
        Ann Thorac Surg. 2006; 81: 1794-1800
        • Artrip J.H.
        • Campbell D.N.
        • Ivy D.D.
        • et al.
        Birth weight and complexity are significant factors for the management of hypoplastic left heart syndrome.
        Ann Thorac Surg. 2006; 82 ([discussion: 1258–9]): 1252-1257
        • Mace L.
        • Bertrand S.
        • Lucron H.
        • et al.
        Paediatric cardiac surgery and autoevaluation: risk score, complexity score, and graphic analysis.
        Arch Mal Coeur Vaiss. 2005; 98: 477-484
        • Blackstone E.H.
        Let the data speak for themselves?.
        Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2004; 7: 192-198
        • Spiegelhalter D.
        • Abrams K.R.
        • Myles J.P.
        Bayesian approaches to clinical trials and health care evaluation.
        John Willeys and Son Editor, Chichester (UK)2004
        • Ashby D.
        Bayesian statistics in medicine: a 25 year review.
        Stat Med. 2006; 25: 3589-3631
        • Lacour-Gayet F.
        • Jacobs J.P.
        • Clarke D.R.
        • et al.
        Performance of surgery for congenital heart disease: shall we wait a generation or look for different statistics?.
        J Thorac Cardiovasc Surg. 2005; 130: 234-235
      4. O'Brien SM, Clarke DR, Jacobs JO, et al. Accuracy of the Aristotle basic complexity score for classifying the mortality and morbidity potential of congenital heart surgery procedures. Presented at the 2006 Meeting of The Society of Thoracic Surgeons (STS), San Diego, January 29, 2007.

      5. Kansy A, Maruszewski B. The new Aristotle Basic Score and RACHS I as predictors of early outcomes in congenital heart surgery: analysis of 5037 consecutive cases. Presented at the Meeting of The Congenital Heart Surgeons' Society (CHSS), Chicago, October 30, 2006.