Abstract 19801: Creation of a Risk Adjustment Model for Adverse Events after Congenital Cardiac Catheterization
Background: As US healthcare increasingly focuses upon outcomes to quantify quality, there is a growing demand for risk models that can account for patient variability at different hospitals so that equitable comparison between institutions can be made. We developed a method for risk-standardizing adverse outcomes following congenital cardiac catheterization.
Methods: Using the national, multicenter, IMPACT® (Improving Pediatric and Adult Congenital Treatment) Registry, all patients undergoing diagnostic or interventional cardiac catheterization between January 2011 and March 2013 were identified. Multivariable hierarchical logistic regression was used to identify patient and procedural characteristics predictive of experiencing a major adverse event (see Figure) following cardiac catheterization.
Results: A total of 19,608 cardiac catheterizations were performed between January 2011 and March 2013. Among all cases, a major adverse event occurred in 378 (1.9%). After multivariable adjustment, 8 variables were identified as critical for risk-standardization: patient age, renal insufficiency, single-ventricle physiology, procedure-type risk group, low systemic saturation, low mixed venous saturation, elevated systemic ventricular end diastolic pressure, and elevated main pulmonary artery pressures (Figure). The model had good discrimination (C-statistic of 0.70), confirmed by bootstrap validation (validation C-statistic of 0.69) and had excellent calibration (slope= 0.97; standard error 0.041; p-value [for difference from 1]= 0.42).
Conclusion: In a large national registry, we developed and validated a model to predict major adverse events following diagnostic or interventional cardiac catheterization for congenital heart disease. This model can support more equitable comparisons between hospitals and can facilitate national quality improvement efforts.
Author Disclosures: N.M. Jayaram: None. R.H. Beekman: Other; Modest; Proctor for Amplatzer Occluder Devices for St. Jude Medical, Inc.. L.N. Benson: None. R.J. Holzer: None. K.J. Jenkins: None. Y. Li: None. G.R. Martin: None. J.W. Moore: None. R. Ringel: None. J.J. Rome: None. J.A. Spertus: Consultant/Advisory Board; Significant; American College of Cardiology Foundation. R.N. Vincent: None. L. Bergersen: Consultant/Advisory Board; Modest; Consultant for 480 Biomedical.
- © 2014 by American Heart Association, Inc.