Congenital Heart Surgery in Hawaii, Outcome Analysis Using the Risk Adjustment Method (RACHS-1)

  • Jennifer Sasaki, United States
  • Dr James Sim, Kapiolani Medical Center for Women and Children, United States
  • Dr Carlos Moreno-Cabral, Kapiolani Medical Center for Women and Children, United States
  • Dr D Venu Reddy, Kapiolani Medical Center for Women and Children, United States
  • Dr Lance Shirai, Kaiser Permanente Clinic - Honolulu, United States
  • Dr Christopher Mahnke, Tripler Army Medical Center, United States
  • Dr John Moore, Rady's Children's Hospital of San Diego, United States
  • Dr John Lamberti, Rady's Children's Hospital of San Diego, United States

    • Objective: Pediatric heart surgery in Hawaii faces many challenges due to its geographic isolation and small surgical volume. Since 1995, a surgical program was adopted at Kapiolani Medical Center (KMC) in Honolulu. Elective cases of intermediate complexity were performed assisted by an experienced visiting pediatric heart surgeon on regular interval. We review the surgical outcome using Risk Adjustment in Congenital Heart Surgery (RACHS-1) model.

    Methods: Patient under18 year’s old undergoing heart surgery at KMC was reviewed from January 1st, 2001 to June 22nd, 2007. Each case was classified according to RACHS-1. Additional risk factors: age, prematurity, combination procedures and major structural anomalies, were included in the final multivariable analysis. Outcome was compared with two multi-institutional data sets: the Pediatric Cardiac Care Consortium (PCCC) and Hospital Discharge (HD).

    Results: 494 surgical cases were reviewed. 205 cases were excluded (age over 18, prematurity, missing data, unlisted risk category). 289 cases were assigned to RACHS-1 risk categories, (77 level I, 127 level II, 84 level III, and 1 level IV). There were three (1%) in hospital mortality (95% CI, 0.23 – 7.16). The RACHS-1 multivariable model predicted mortality of 6.72 and 5.69 using PCCC and HD data respectively.

    Conclusion: The mortality of pediatric heart surgery in Hawaii is lower than the predicted number based on RACHS-1 model, but did not reach statistical significance due to the small sample size. However, the data demonstrate satisfactory clinical outcome can be achieved in a small, self contained pediatric heart surgery program such as in Hawaii.