Procedure-type risk categories for pediatric and congenital cardiac catheterization

Lisa Bergersen, Kimberlee Gauvreau, Audrey Marshall, Jacqueline Kreutzer, Robert Beekman, Russel Hirsch, Susan Foerster, David Balzer, Julie Vincent, William Hellenbrand, Ralf Holzer, John Cheatham, John Moore, James Lock, Kathy Jenkins

Research output: Contribution to journalArticlepeer-review

88 Scopus citations

Abstract

Background-The Congenital Cardiac Catheterization Project on Outcomes (C3PO) was established to develop outcome assessment methods for pediatric catheterization. Methods and Results-Six sites have been recording demographic, procedural and immediate outcome data on all cases, using a web-based system since February 2007. A sample of data was independently audited for validity and data completeness. In 2006, participants categorized 84 procedure types into 6 categories by anticipated risk of an adverse event (AE). Consensus and empirical methods were used to determine final procedure risk categories, based on the outcomes: any AE (level 1 to 5); AE level 3, 4, or 5; and death or life-threatening event (level 4 or 5). The final models were then evaluated for validity in a prospectively collected data set between May 2008 and December 31, 2009. Between February 2007 and April 2008, 3756 cases were recorded, 558 (14.9%) with any AE; 226 (6.0%) level 3, 4, or 5; and 73 (1.9%) level 4 or 5. General estimating equations models using 6 consensus-based risk categories were moderately predictive of AE occurrence (c-statistics: 0.644, 0.664, and 0.707). The participant panel made adjustments based on the collected empirical data supported by clinical judgment. These decisions yielded 4 procedure risk categories; the final models had improved discrimination, with c-statistics of 0.699, 0.725, and 0.765. Similar discrimination was observed in the performance data set (n=7043), with c-statistics of 0.672, 0.708, and 0.721. Conclusions-Procedure-type risk categories are associated with different complication rates in our data set and could be an important variable in risk adjustment models for pediatric catheterization.

Original languageEnglish
Pages (from-to)188-194
Number of pages7
JournalCirculation: Cardiovascular Interventions
Volume4
Issue number2
DOIs
StatePublished - Apr 2011

Keywords

  • Cardiac catheterization
  • Cardiovascular interventions
  • Complications
  • Heart defects congenital
  • Outcome

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