108. A Novel Risk Prediction Model for 1-Year Mortality Following Congenital Heart Surgery − Analysis of >10,000 Patients Over 10 Years
Children’s Nebraska/University of Nebraska Medical Center
Omaha, NE
United States - Contact Me
Ram Kumar Subramanyan, MD, PhD, FACS is a pediatric cardiothoracic surgeon-scientist. After finishing medical school in India, he completed his General Surgery training at the University of Southern California (“USC”) under Tom R. DeMeester, MD. He subsequently trained in Thoracic Surgery at USC and Congenital Cardiac Surgery at Children’s Hospital Los Angeles, under Vaughn A. Starnes, MD. He also has a PhD from USC, studying membrane protein biology and cell-cell interaction.
Dr. Subramanyan is currently the Chief of Pediatric Cardiothoracic Surgery at Children’s Nebraska Omaha and Professor of Surgery at University of Nebraska Medical Center. In addition to practicing the full spectrum of pediatric cardiothoracic surgery, he runs an extramurally funded research lab that studies cardiac outflow track development and cardiomyocyte biology. He participates in robust translational research initiatives, including being the site lead on regenerative therapy clinical trials for children with single right ventricle heart disease. Dr. Subramanyan has published over 100 peer-reviewed publications, authored several textbook chapters, and has delivered many invited lectures and presentations. He is the editor of the congenital section of the Seminars in Thoracic and Cardiovascular Surgery and is on the editorial board of three other major surgical journals. He has served on the study sections of various funding agencies, including the NIH and American Heart Association and has served as Chair of the Society of Thoracic Surgeons Congenital Heart Surgery Database. He is currenlty the Chair of Council on Quality and Research of the STS. He is also Treasurer of the Western Thoracic Surgical Association and participates in several committees in national organizations.
Mount Sinai Health System
New York, NY
United States - Contact Me
Aditya Sengupta is a PGY-5 resident in the 6-year Integrated Cardiothoracic Surgery Training Program at The Mount Sinai Hospital in New York.
Description
Methods: This was a single-center, retrospective review of consecutive patients who underwent CHS (the index operation) from 01/2011-01/2021 with known survival status at one year following discharge from the index hospitalization. The primary outcome was post-discharge mortality at one year. Variables of interest included age, prematurity, non-cardiac anomalies or syndromes, the Childhood Opportunity Index (COI, a US Census tract-based, nationally-normed composite metric of contemporary child neighborhood opportunity comprising 29 indicators across education, health/environment, and socioeconomic domains), STAT mortality category, major adverse postoperative complications (e.g., prolonged mechanical ventilation, renal failure, etc.), and the Residual Lesion Score (RLS, a quality improvement metric that assesses residual lesion severity at discharge based on echocardiographic criteria and pre-discharge unplanned reinterventions). Logistic regression models were used to develop a weighted risk score for the primary outcome. The final prediction model was internally validated using a bootstrapping resampling approach to estimate the optimism-corrected C-statistic based on 500 samples.
Results: Of 10,412 consecutive patients who were discharged following CHS, 8,827 (84.8%) met entry criteria. The median age was 1.9 (IQR 0.3-8.1) years. There were 195 (2.2%) deaths at one year post-discharge. Uni- and multivariable logistic regression models of the primary outcome are shown in Table 1. A weighted risk score was formulated based on the variables in the final risk prediction model (Table 1), which included all aforementioned factors of interest (this model had a C-statistic of 0.82, 95% CI 0.80-0.85). The median risk score was 7 (IQR 5-9) points. Patients were categorized as low (score 0-5), medium (score 6-10), high (score 11-15), or very high (score 16-20) risk for 1-year mortality. The predicted probability of mortality was 0.3 ± 0.1%, 1.5 ± 0.9%, 8.0 ± 4.3%, and 34.5 ± 8.2% for low, medium, high, and very high risk patients, respectively.
Conclusions: A risk prediction model of 1-year mortality may guide prognostication and follow-up of high-risk patients following discharge from CHS.