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Jeffrey P Jacobs - One of the best experts on this subject based on the ideXlab platform.
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Empirically Based Tools for Analyzing Mortality and Morbidity Associated with Congenital Heart Surgery
Pediatric and Congenital Cardiac Care, 2014Co-Authors: Marshall L. Jacobs, Sara K Pasquali, Jeffrey P Jacobs, Sean M. O BrienAbstract:Congenital Heart Surgery outcomes analysis requires reliable methods of estimating the risk of adverse outcomes. In the past, methods used for risk adjusted comparisons of outcomes from congenital Heart Surgery relied on expert opinion about perceived complexity of treatment. The development and growth of national and international congenital Heart Surgery clinical registry databases has resulted in the availability of large datasets for analysis. The adoption by these registries of standardized nomenclature and definitions and their use of a uniform set of data elements has made it possible to apply robust statistical methodology to these large sets of objective data to develop empirically based tools for analysis of mortality and morbidity associated with congenital Heart Surgery. The Society of Thoracic Surgeons – European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Score and Categories (STAT Mortality Categories) and the Society of Thoracic Surgeons Congenital Heart Surgery Morbidity Score and Categories are now widely used in reporting of outcomes, in quality assessment, and in outcomes research.
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evaluation of failure to rescue as a quality metric in pediatric Heart Surgery an analysis of the sts congenital Heart Surgery database
The Annals of Thoracic Surgery, 2012Co-Authors: Sara K Pasquali, Sean M Obrien, Xia He, Jeffrey P Jacobs, Marshall L. Jacobs, William J GaynorAbstract:Background Failure to rescue (FTR; the probability of death after a complication) has been adopted as a quality metric in adult cardiac Surgery, in which it has been shown that high-performing centers with low mortality rates do not have fewer complications, but rather lower mortality in those who experience a complication (lower FTR). It is unknown whether this holds true in pediatric Heart Surgery. We characterized the relationship between complications, FTR, and mortality in this population. Methods Children (0 to 18 years) undergoing Heart Surgery at centers participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2006 to 2009) were included. Outcomes were examined in multivariable analysis adjusting for patient characteristics, surgical risk category, and within-center clustering. Results This study included 40,930 patients from 72 centers. Overall in-hospital mortality was 3.7%, 39.3% had a postoperative complication, and the FTR rate (number of deaths in those with a complication) was 9.1%. When hospitals were characterized by in-hospital mortality rate, there was no difference across hospital mortality tertiles in the complication rate in adjusted analysis; however, hospitals in the lowest mortality tertile had significantly lower FTR rates (6.6% versus 12.4%; p Conclusions This analysis suggests that hospitals with low mortality rates do not have fewer complications after pediatric Heart Surgery, but instead have lower mortality in those who experience a complication (lower FTR). Further investigation into FTR as a quality metric in pediatric Heart Surgery is warranted.
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Centre variation in cost and outcomes for congenital Heart Surgery
Cardiology in the Young, 2012Co-Authors: Sara K Pasquali, Jeffrey P Jacobs, J. William Gaynor, Michael Gaies, Marshall L. JacobsAbstract:Although overall outcomes for children undergoing Heart Surgery have improved, there is a significant variation in outcomes across hospitals. This review discusses the variation in cost and outcomes across centres performing congenital Heart Surgery, potential underlying mechanisms, and efforts to reduce variation and improve outcome.
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case complexity scores in congenital Heart Surgery a comparative study of the aristotle basic complexity score and the risk adjustment in congenital Heart Surgery rachs 1 system
The Journal of Thoracic and Cardiovascular Surgery, 2007Co-Authors: Osman O Alradi, Jeffrey P Jacobs, Frank E Harrell, Christopher A Caldarone, Brian W Mccrindle, Gail M Williams, Glen S Van Arsdell, William G WilliamsAbstract:Objective The Aristotle Basic Complexity score and the Risk Adjustment in Congenital Heart Surgery system were developed by consensus to compare outcomes of congenital cardiac Surgery. We compared the predictive value of the 2 systems. Methods Of all index congenital cardiac operations at our institution from 1982 to 2004 (n = 13,675), we were able to assign an Aristotle Basic Complexity score, a Risk Adjustment in Congenital Heart Surgery score, and both scores to 13,138 (96%), 11,533 (84%), and 11,438 (84%) operations, respectively. Models of in-hospital mortality and length of stay were generated for Aristotle Basic Complexity and Risk Adjustment in Congenital Heart Surgery using an identical data set in which both Aristotle Basic Complexity and Risk Adjustment in Congenital Heart Surgery scores were assigned. The likelihood ratio test for nested models and paired concordance statistics were used. Results After adjustment for year of operation, the odds ratios for Aristotle Basic Complexity score 3 versus 6, 9 versus 6, 12 versus 6, and 15 versus 6 were 0.29, 2.22, 7.62, and 26.54 ( P P 2 = 162, P 2 = 13.4, P = .009). Neither system fully adjusted for the child’s age. The Risk Adjustment in Congenital Heart Surgery scores were more concordant with length of stay compared with Aristotle Basic Complexity scores ( P Conclusions The predictive value of Risk Adjustment in Congenital Heart Surgery is higher than that of Aristotle Basic Complexity. The use of Aristotle Basic Complexity or Risk Adjustment in Congenital Heart Surgery as risk stratification and trending tools to monitor outcomes over time and to guide risk-adjusted comparisons may be valuable.
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Congenital Heart Surgery nomenclature and database project
The Japanese Journal of Thoracic and Cardiovascular Surgery, 2002Co-Authors: Hiromi Kurosawa, Jeffrey P Jacobs, Marshall L. Jacobs, J. William Gaynor, Martin Elliott, François Lacour-gayet, Christo I. Tchervenkov, Bohdan Maruszewski, Constantine MavroudisAbstract:In 1998, the first report of the Society of Thoracic Surgery (STS) National Congenital Heart Surgery Database defined clinical features for 18 congenital Heart disease categories, providing a significant amount of important information and pinpointing database strengths and weaknesses. Following this report, the STS Congenital Heart Surgery Committee, working with the European Association of Cardio-Thoracic Surgery and the European Congenital Heart Surgeons Foundation, initiated the International Congenital Heart Surgery and Nomenclature Database Project. To standardize nomenclature and reporting strategies and establish a foundation for an international congenital Heart Surgery database. The project’s first report was published in the Annals of Thoracic Surgery in April 2000. The current report outlines modifications to the minimal dataset and diagnosis and procedure short lists.
Marshall L. Jacobs - One of the best experts on this subject based on the ideXlab platform.
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Adult Congenital Heart Surgery A Thing of Beauty
World Journal for Pediatric and Congenital Heart Surgery, 2016Co-Authors: Marshall L. Jacobs, E. CameronAbstract:A year ago, we had the good fortune to participate in the planning of an International Symposium on Grown-Up Congenital Heart Disease. It was a collaborative effort between Policlinico Agostino Gemelli/Universita Cattolica del Sacro Cuore in Rome and Johns Hopkins University. Two very interesting articles from this symposium, one ‘‘medical’’ and one ‘‘surgical,’’ are included in this issue of World Journal for Pediatric and Congenital Heart Surgery. In the early stages of planning the program for the 2015 Symposium in Rome, we sent an informal opinion survey to colleagues engaged in the practices of cardiac Surgery and cardiology across the United States. The objective of the survey was to seek an answer to the question ‘‘Is It Adult Congenital Heart Surgery?’’ and to see whether we could then summarize a position that would qualify as ‘‘consensus.’’ What we learned is that ‘‘Adult Congenital Heart Surgery, like other things of beauty, is in the eye of the beholder.’’ A list of 37 specific clinical scenarios was provided to the survey recipients, and they were asked to simply respond YES or NO to the question ‘‘Is it adult congenital Heart Surgery?’’ The question was not whether the operations described should be done in a general hospital or a children’s hospital . . . . . .Not whether they should be entered in a Congenital Heart Surgery Database or an Adult Cardiac Surgery Database . . . . . .Not whether the surgeons should have specialized training or credentials . . . The question was, simply, which scenarios do you consider to be ‘‘Adult Congenital Heart Surgery?’’ The survey was sent to thirty-six individuals, made up of equal numbers of Pediatric/Congenital Heart Surgeons, Adult Cardiac Surgeons, and Cardiologists who specialize in the care of adult patients with congenital Heart disease, all in the United States. The Adult Cardiac Surgeons were deliberately chosen on the basis of having experience and expertise with complex cardiac Surgery including aortic Surgery – no run-ofthe-mill ‘‘valve and CABG guys’’ among them! When the answers provided by the thirty respondents were considered as a single group, more than two-thirds of the group had replied ‘‘YES’’ with respect to roughly one half of the clinical scenarios. These included such things as:
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Empirically Based Tools for Analyzing Mortality and Morbidity Associated with Congenital Heart Surgery
Pediatric and Congenital Cardiac Care, 2014Co-Authors: Marshall L. Jacobs, Sara K Pasquali, Jeffrey P Jacobs, Sean M. O BrienAbstract:Congenital Heart Surgery outcomes analysis requires reliable methods of estimating the risk of adverse outcomes. In the past, methods used for risk adjusted comparisons of outcomes from congenital Heart Surgery relied on expert opinion about perceived complexity of treatment. The development and growth of national and international congenital Heart Surgery clinical registry databases has resulted in the availability of large datasets for analysis. The adoption by these registries of standardized nomenclature and definitions and their use of a uniform set of data elements has made it possible to apply robust statistical methodology to these large sets of objective data to develop empirically based tools for analysis of mortality and morbidity associated with congenital Heart Surgery. The Society of Thoracic Surgeons – European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Score and Categories (STAT Mortality Categories) and the Society of Thoracic Surgeons Congenital Heart Surgery Morbidity Score and Categories are now widely used in reporting of outcomes, in quality assessment, and in outcomes research.
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evaluation of failure to rescue as a quality metric in pediatric Heart Surgery an analysis of the sts congenital Heart Surgery database
The Annals of Thoracic Surgery, 2012Co-Authors: Sara K Pasquali, Sean M Obrien, Xia He, Jeffrey P Jacobs, Marshall L. Jacobs, William J GaynorAbstract:Background Failure to rescue (FTR; the probability of death after a complication) has been adopted as a quality metric in adult cardiac Surgery, in which it has been shown that high-performing centers with low mortality rates do not have fewer complications, but rather lower mortality in those who experience a complication (lower FTR). It is unknown whether this holds true in pediatric Heart Surgery. We characterized the relationship between complications, FTR, and mortality in this population. Methods Children (0 to 18 years) undergoing Heart Surgery at centers participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2006 to 2009) were included. Outcomes were examined in multivariable analysis adjusting for patient characteristics, surgical risk category, and within-center clustering. Results This study included 40,930 patients from 72 centers. Overall in-hospital mortality was 3.7%, 39.3% had a postoperative complication, and the FTR rate (number of deaths in those with a complication) was 9.1%. When hospitals were characterized by in-hospital mortality rate, there was no difference across hospital mortality tertiles in the complication rate in adjusted analysis; however, hospitals in the lowest mortality tertile had significantly lower FTR rates (6.6% versus 12.4%; p Conclusions This analysis suggests that hospitals with low mortality rates do not have fewer complications after pediatric Heart Surgery, but instead have lower mortality in those who experience a complication (lower FTR). Further investigation into FTR as a quality metric in pediatric Heart Surgery is warranted.
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Centre variation in cost and outcomes for congenital Heart Surgery
Cardiology in the Young, 2012Co-Authors: Sara K Pasquali, Jeffrey P Jacobs, J. William Gaynor, Michael Gaies, Marshall L. JacobsAbstract:Although overall outcomes for children undergoing Heart Surgery have improved, there is a significant variation in outcomes across hospitals. This review discusses the variation in cost and outcomes across centres performing congenital Heart Surgery, potential underlying mechanisms, and efforts to reduce variation and improve outcome.
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Congenital Heart Surgery nomenclature and database project
The Japanese Journal of Thoracic and Cardiovascular Surgery, 2002Co-Authors: Hiromi Kurosawa, Jeffrey P Jacobs, Marshall L. Jacobs, J. William Gaynor, Martin Elliott, François Lacour-gayet, Christo I. Tchervenkov, Bohdan Maruszewski, Constantine MavroudisAbstract:In 1998, the first report of the Society of Thoracic Surgery (STS) National Congenital Heart Surgery Database defined clinical features for 18 congenital Heart disease categories, providing a significant amount of important information and pinpointing database strengths and weaknesses. Following this report, the STS Congenital Heart Surgery Committee, working with the European Association of Cardio-Thoracic Surgery and the European Congenital Heart Surgeons Foundation, initiated the International Congenital Heart Surgery and Nomenclature Database Project. To standardize nomenclature and reporting strategies and establish a foundation for an international congenital Heart Surgery database. The project’s first report was published in the Annals of Thoracic Surgery in April 2000. The current report outlines modifications to the minimal dataset and diagnosis and procedure short lists.
Constantine Mavroudis - One of the best experts on this subject based on the ideXlab platform.
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Congenital Heart Surgery nomenclature and database project
The Japanese Journal of Thoracic and Cardiovascular Surgery, 2002Co-Authors: Hiromi Kurosawa, Jeffrey P Jacobs, Marshall L. Jacobs, J. William Gaynor, Martin Elliott, François Lacour-gayet, Christo I. Tchervenkov, Bohdan Maruszewski, Constantine MavroudisAbstract:In 1998, the first report of the Society of Thoracic Surgery (STS) National Congenital Heart Surgery Database defined clinical features for 18 congenital Heart disease categories, providing a significant amount of important information and pinpointing database strengths and weaknesses. Following this report, the STS Congenital Heart Surgery Committee, working with the European Association of Cardio-Thoracic Surgery and the European Congenital Heart Surgeons Foundation, initiated the International Congenital Heart Surgery and Nomenclature Database Project. To standardize nomenclature and reporting strategies and establish a foundation for an international congenital Heart Surgery database. The project’s first report was published in the Annals of Thoracic Surgery in April 2000. The current report outlines modifications to the minimal dataset and diagnosis and procedure short lists.
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Congenital Heart Surgery Nomenclature and Database Project: update and proposed data harvest.
The Annals of Thoracic Surgery, 2002Co-Authors: J. William Gaynor, Jeffrey P Jacobs, Marshall L. Jacobs, Martin Elliott, François Lacour-gayet, Christo I. Tchervenkov, Bohdan Maruszewski, Constantine MavroudisAbstract:The first report of The Society of Thoracic Surgeons (STS) National Congenital Heart Surgery Database in 1998 reported the clinical features of 18 congenital Heart categories. The report provided a significant amount of important information and also highlighted the strengths and weaknesses of the existing database. Following this report the STS Congenital Heart Surgery Committee in cooperation with the European Association of Cardio-Thoracic Surgery and the European Congenital Heart Surgeons Foundation initiated the International Congenital Heart Surgery Nomenclature and Database Project. The goal was to begin the standardization of nomenclature reporting strategies and establish the foundations for an international congenital Heart Surgery database. The first report of the International Congenital Heart Surgery Nomenclature Project was published in The Annals of Thoracic Surgery in April 2000. The current report outlines modifications to the minimum dataset as well as the diagnoses and procedure short lists. Plans for the next STS National Congenital Heart Surgery Database harvest are also presented.
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Virtues of a worldwide congenital Heart Surgery database
Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual, 2002Co-Authors: Constantine Mavroudis, Jeffrey P Jacobs, Martin Elliott, Melanie Gevitz, Jeffrey P. GoldAbstract:Abstract The rationale for a congenital Heart Surgery database lies in the organized manner in which information can be compiled to accomplish programmatic evaluation, monitor clinical outcomes, comply with governmental requirements, perform retrospective and prospective clinical studies, and participate in local, national, and global improvement strategies. The task of inaugurating an effective congenital Heart Surgery database has taken many years and involved concurrent development efforts at multiple sites. Two such efforts took place in North America with the Society of Thoracic Surgeons Congenital Heart Surgery Database, and in Europe with the European Congenital Heart Defects Database. These initial efforts provided the impetus for development of an international congenital Heart Surgery database that would allow scientific exchanges on an international scale and promote multi-institutional evaluation of congenital Heart Surgery. Sample outcome templates from the Society of Thoracic Surgeons and the European Association for Cardio-thoracic Surgery's accepted minimum database data set are reviewed for the specific diagnostic entry ventricular septal defect, to familiarize the reader with potential available data summaries and outcome analyses, including risk stratification, when data harvest is performed.In Europe, the agreed upon minimum data set are now collected as part of the Pediatric European Cardiac Surgical Registry, while in North America users of the CardioAccess database and users of the minimum data set downloaded from the Society of Thoracic Surgeons web site are being notified of plans for a 2002 data harvest incorporating the minimum database data set. It is likely that the extant voluntary, minimal data set congenital Heart Surgery database will be replaced by a mandated system required by states, provinces, and countries. Data collection schemes and data validation programs will become standardized, which will result in improved data quality and uniform congenital Heart center participation. As participation with valid data approaches 100% of congenital Heart centers, the power and importance of the database increases exponentially. Reliable information can be used to assess residency/fellowship programs, resource allocation, major therapeutic trends, manpower issues, and in the end, all initiatives that will require accurate information. Copyright © 2002 by W.B. Saunders Company
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Congenital Heart Surgery Nomenclature and Database Project: update and proposed data harvest.
European Journal of Cardio-Thoracic Surgery, 2002Co-Authors: Bohdan Maruszewski, Jeffrey P Jacobs, Marshall L. Jacobs, Hiromi Kurosawa, J. William Gaynor, François Lacour-gayet, Christo I. Tchervenkov, Martin J Elliott, Constantine MavroudisAbstract:In 1998, the first report of the Society of Thoracic Surgery (STS) National Congenital Heart Surgery Database reported the clinical features of 18 congenital Heart categories. The report provided a significant amount of important information and also highlighted the strengths and weaknesses of the existing database. Following this report, the STS Congenital Heart Surgery Committee, in cooperation with the European Association of Cardio-Thoracic Surgery and the European Congenital Heart Surgeons Foundation, initiated the International Congenital Heart Surgery and Nomenclature Database Project. The goal was to begin the standardization of nomenclature and reporting strategies and establish the foundations for an international congenital Heart Surgery database. The first report of the International Congenital Heart Surgery Nomenclature Project was published in the Annals of Thoracic Surgery in April 2000. The current report outlines modifications to the minimal dataset, as well as the diagnosis and procedure short lists.
William J Gaynor - One of the best experts on this subject based on the ideXlab platform.
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evaluation of failure to rescue as a quality metric in pediatric Heart Surgery an analysis of the sts congenital Heart Surgery database
The Annals of Thoracic Surgery, 2012Co-Authors: Sara K Pasquali, Sean M Obrien, Xia He, Jeffrey P Jacobs, Marshall L. Jacobs, William J GaynorAbstract:Background Failure to rescue (FTR; the probability of death after a complication) has been adopted as a quality metric in adult cardiac Surgery, in which it has been shown that high-performing centers with low mortality rates do not have fewer complications, but rather lower mortality in those who experience a complication (lower FTR). It is unknown whether this holds true in pediatric Heart Surgery. We characterized the relationship between complications, FTR, and mortality in this population. Methods Children (0 to 18 years) undergoing Heart Surgery at centers participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2006 to 2009) were included. Outcomes were examined in multivariable analysis adjusting for patient characteristics, surgical risk category, and within-center clustering. Results This study included 40,930 patients from 72 centers. Overall in-hospital mortality was 3.7%, 39.3% had a postoperative complication, and the FTR rate (number of deaths in those with a complication) was 9.1%. When hospitals were characterized by in-hospital mortality rate, there was no difference across hospital mortality tertiles in the complication rate in adjusted analysis; however, hospitals in the lowest mortality tertile had significantly lower FTR rates (6.6% versus 12.4%; p Conclusions This analysis suggests that hospitals with low mortality rates do not have fewer complications after pediatric Heart Surgery, but instead have lower mortality in those who experience a complication (lower FTR). Further investigation into FTR as a quality metric in pediatric Heart Surgery is warranted.
Lionel Camilleri - One of the best experts on this subject based on the ideXlab platform.
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Are all heparins safe for on-pump Heart Surgery?
Expert Opinion on Drug Safety, 2016Co-Authors: Kasra Azarnoush, Bruno Pereira, Aurélien Lebreton, Marie-christine Zenut, Chouki Chenaf, Eljezi Vedat, Bernard Cosserant, Damien Bouvier, Nicolas D’ostrevy, Lionel CamilleriAbstract:Are all heparins safe for on-pump Heart Surgery?
