Heart surgery

RACHS-2: a new risk stratification tool for pediatric congenital heart surgery

Risk Stratification for Congenital Heart Surgery (RACHS-2) is an accurate risk stratification method for pediatric heart surgery, using administrative data from the International Classification of Diseases – 10th Revision (ICD-10). These findings were published in the Journal of the American College of Cardiology.

Researchers sought to develop a pediatric congenital heart surgery risk stratification method to predict operative mortality using publicly available empirical administrative data. To optimize sensitivity and specificity, researchers repeatedly refined the RACHS-2 stratification system through a pediatric health information system claims training dataset against clinical data held locally by the Society of Thoracic Surgeons-Congenital Heart Surgery (STS-CHS) of 4 pediatrics. hospitals.

Locally held clinical validation data was obtained from the New York Congenital Heart Surgeons Collaborative for Longitudinal Outcomes and Utilization of Resources STS-CHS, excluding repetitive data from New York Presbyterian/Morgan Stanley Children’s Hospital and New York- Presbyterian/Komansky Children’s Hospital. New York State Medicaid claims were used as a second administrative data source validation for RACHS-2. With only 1.0% false positives, 99.6% of the total congenital heart surgery cases were captured by the RACHS-2.


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Investigators used statistical logistic regression to compare the ability of RACHS-2 to predict operative mortality versus STAT mortality categories. Clinical data included patients under the age of 18 who underwent cardiopulmonary or non-cardiopulmonary bypass congenital heart surgery between October 1, 2015 and December 31, 2019. Administrative data were from the same period of all patients with an ICD-10 code designating cardiac surgery.

RACHS-2 accurately predicted operative mortality in training data (0.76, adjusted for RACHS-2; 95% CI, 0.72-0.80) and validation data (0.84, adjusted for RACHS-2; 95% CI, 0.80-0.89), and for operative mortality in training data adjusted for STAT mortality categories (0.75; 95% CI, 0.71- 0.79) and adjusted validation data for STAT mortality categories (0.84; 95% CI, 0.79-0.89).

The researchers urge caution when using the RACHS-2 code for liberal assessment of individual procedures, as not all ICD-10 codes map accurately.

The RACHS-2 statistical code is publicly available on request from the author of the corresponding study. “This work represents a novel method of risk identification and stratification for pediatric cardiac surgery using ICD-10 administrative data,” the study authors wrote. “Creating and sharing this tool expands the ability of researchers, policy makers, and hospitals to use administrative data sources to assess and improve outcomes, resource needs, reimbursement, and health disparities for patients. children with congenital heart disease. »

Reference

Allen P, Zafar F, Mi J, et al. Congenital Heart Surgery Risk Stratification for ICD-10 (RACHS-2) Administrative Data. J Am Coll Cardiol. Published online February 8, 2022.

doi:10.1016/j.jacc.2021.11.036