Update from the International Working Group for mapping and coding of nomenclatures for Paeditric and Congenital Heart Disease.

THE FIRST INTERNATIONAL SUMMIT ON Nomenclature for Congenital Heart Disease was held on 27 May, 2001, in Toronto, Canada, just prior to the 3rd World Congress of Pediatric Cardiology and Cardiac Surgery. At the Summit, enthusiastic and virtually unanimous support was expressed for the development of a unified system for describing congenital cardiac malformations, as well as the related procedures used to palliate or correct them. At the meeting of the International Nomenclature Committee for Paediatric and Congenital Heart Disease that immediately followed the Summit, a working group was appointed and given the following tasks: * Finalise the crossmap of the nomenclature \u201cShort Lists\u201d of the European Paediatric Cardiac Code1 and the International Congenital Heart Surgery Nomenclature and Database Project,2 both published in 2000. * Crossmap the \u201cLong Lists\u201d and develop a single \u201csuper-tree\u201d of nomenclature, to be called the International Paediatric and Congenital Cardiac Code, by the time of the next World Congress in Buenos Aires, Argentina. * Report back to the International Committee to diffuse information about progress. Mid-way through the time allotted to complete these tasks, therefore, we present a brief update on the progress of the working group to date. For additional details, we refer the reader to a full report outlining the background and events leading to the founding of the International Nomenclature Project for Paediatric and Congenital Heart Disease (Fig. 1), published in Cardiology in the Young in 2002.

What is operative mortality? Defining death in a surgical registry database: A report of the STS Congenital Database Taskforce and the Joint EACTS-STS Congenital Database Committee

The most concrete and universal outcome measure used in databases, whether governmental, professional society, research, or third-party payer, is operative mortality. To assure congruous data entry by multiple users of The Society of Thoracic Surgeons and the European Association for Cardiothoracic Surgery congenital heart surgery databases, operative mortality must be clearly defined. Traditionally, operative mortality has been defined as any death, regardless of cause, occurring (1) within 30 days after surgery in or out of the hospital, and (2) after 30 days during the same hospitalization subsequent to the operation. Differing hospital practices result in problems in use of the latter part of the definition (eg, the pediatric hospital that provides longer-term care will have higher mortality rates than one which transfers patients to another institution for such care). In addition, because of the significant number of pediatric multiple operation hospitalizations, issues of assignment of mortality to a specific operation within the hospitalization, calculation of operative mortality rates (operation based vs patient admission based), and discharge other than to home must be addressed and defined. We propose refinements to the definition of operative mortality which specifically meet the needs of our professional societies' multi-institutional registry databases, and at the same time are relevant and appropriate with respect to the goals and purposes of administrative databases, government agencies, and the general public

Initial application in the EACTS and STS Congenital Heart Surgery Databases of an empirically derived methodology of complexity adjustment to evaluate surgical case mix and results.

OBJECTIVES: Outcomes evaluation is enhanced by assignment of operative procedures to appropriate categories based upon relative average risk. Formal risk modelling is challenging when a large number of operation types exist, including relatively rare procedures. Complexity stratification provides an alternative methodology. We report the initial application in the Congenital Heart Surgery Databases of the Society of Thoracic Surgeons (STS) and the European Association for Cardio-thoracic Surgery (EACTS) of an empirically derived system of complexity adjustment to evaluate surgical case mix and results. METHODS: Complexity stratification is a method of analysis in which the data are divided into relatively homogeneous groups (called strata). A complexity stratification tool named the STS-EACTS Congenital Heart Surgery Mortality Categories (STAT Mortality Categories) was previously developed based on the analysis of 77 294 operations entered in the Congenital Heart Surgery Databases of EACTS (33 360 operations) and STS (43 934 patients). Procedure-specific mortality rate estimates were calculated using a Bayesian model that adjusted for small denominators. Operations were sorted by increasing risk and grouped into five categories (the STAT Mortality Categories) that were designed to minimize within-category variation and maximize between-category variation. We report here the initial application of this methodology in the EACTS Congenital Heart Surgery Database (47 187 operations performed over 4 years: 2006-09) and the STS Congenital Heart Surgery Database (64 307 operations performed over 4 years: 2006-09). RESULTS: In the STS Congenital Heart Surgery Database, operations classified as STAT Mortality Categories 1-5 were (1): 17332, (2): 20114, (3): 9494, (4): 14525 and (5): 2842. Discharge mortality was (1): 0.54%, (2): 1.6%, (3): 2.4%, (4): 7.5% and (5): 17.8%. In the EACTS Congenital Heart Surgery Database, operations classified as STAT Mortality Categories 1-5 were (1): 19874, (2): 12196, (3): 5614, (4): 8287 and (5): 1216. Discharge mortality was (1): 0.99%, (2): 2.9%, (3): 5.0%, (4): 10.3% and (5): 25.0%. CONCLUSIONS: The STAT Mortality Categories facilitate analysis of outcomes across the wide spectrum of distinct congenital heart surgery operations including infrequently performed procedures