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Risk Adjustment For Congenital Heart Surgery For ICD-10 Administrative Data (RACHS-2)
Philip Allen, MD, MS1, Farhan Zafar, MD2, Junhui Mi, BA1, Sarah Crook, PhD1, Joyce Woo, MD, MS3, Natalie Jayaram, MD, MSB4, Roosevelt Bryant, III, MD5, Tara Karamlou, MD6, James Tweddell, MD2, Kacie Dragan, MS7, Stephen Cook, MD8, Edward Hannan, PhD9, Jane Newburger, MD, MPH10, Emile Bacha, MD11, Robert Vincent, MD12, Khanh Nguyen, MD13, Kathleen Walsh-Spoonhower, MD14, Ralph Mosca, MD15, Neil Devejian, MD16, Steven Kamenir, MD17, George Alfieris, MD Michael Swartz, PhD18, John Billings, JD7, David Meyer, MD, MS19, Erin Paul, MD20, Brett Anderson, MD, MBA, MS1.
1Division of Pediatric Cardiology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA, 2Division of Cardiac Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA, 3Division of Pediatric Cardiology, Lurie Children’s Hospital, Chicago, IL, USA, 4Division of Pediatric Cardiology, Children's Mercy Hospital, Kansas City, MO, USA, 5Division of Cardiac Surgery, Phoenix Children’s Hospital, Phoenix, AZ, USA, 6Department of Pediatric Cardiac Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland Clinic, OH, USA, 7New York University Wagner Graduate School of Public Service, New York, NY, USA, 8New York State Department of Health; Offices of Health Insurance Programs, New York, NY, USA, 9University at Albany School of Public Health,, Rensselaer, NY, USA, 10Department of Pediatric Cardiology; Boston Children’s Hospital, Boston, MA, USA, 11Department of Cardiothoracic Surgery; NewYork-Presbyterian / Columbia University Irving Medical Center & Weill Cornell Medical Center, New York, NY, USA, 12Division of Pediatric Cardiology; Westchester Medical Center, Westchester, NY, USA, 13Department of Cardiac Surgery; Westchester Medical Center, Westchester, NY, USA, 14Renaissance School of Medicine at Stony Brook University, New York, NY, USA, 15Department of Cardiothoracic Surgery; New York University, New York, NY, USA, 16Division of Pediatric Cardiothoracic Surgery; Albany Medical College, Albany, NY, USA, 17Division of Pediatric Cardiology; Albany Medical College, Albany, NY, USA, 18Division of Cardiac Surgery; University of Rochester Medical Center, Rochester, NY, USA, 19Division of Cardiothoracic Surgery, Cohen Children’s Medical Center of New York, Hofstra-Northwell School of Medicine, Syracuse, NY, USA, 20Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Objectives: Since adoption of International Disease Classification-10 (ICD-10) in 2015, there is no method to risk adjust pediatric cardiac operations in administrative data. The purpose of this study was to develop a novel, empirically-derived, publicly available, Risk Adjustment for Congenital Heart Surgery (RACHS-2) model for ICD-10 administrative data.
Methods: The RACHS-2 model was iteratively and empirically refined in a training dataset of Pediatric Health Information Systems claims to optimize sensitivity and specificity compared to corresponding, locally-held Society of Thoracic Surgeons-Congenital Heart Surgery (STS-CHS) clinical registry data. The model was validated using linked NY Medicaid/STS-CHS data from The NY State Congenital Heart Surgery Collaborative for Longitudinal Outcomes and Utilization of Resources (CHS-COLOUR). Logistic regression was used to compare the ability of RACHS-2 in administrative data to predict operative mortality vs. STAT Mortality Categories in registry data.
Results: The RACHS-2 model captured 99.6% of cases with 1.0% false positives. RACHS-2 predicted operative mortality in training and validation administrative datasets similarly to STAT Mortality Categories in registry data. C-statistics for operative mortality models—adjusted for RACHS-2 and age—in training and validation administrative data were 0.76 and 0.84 (CIs 0.72-0.80, 0.80-0.89); C-statistics—adjusted for STAT Mortality Categories and age—in corresponding clinical registry data were 0.75 and 0.84 (CIs 0.71-0.79, 0.77-0.89).
Conclusions: RACHS-2 is a risk model for pediatric cardiac surgery for ICD-10 administrative data, validated in two separate administrative/registry linked datasets.


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