Department of Pediatric Thoracic and Cardiovascular Surgery, Congenital Cardiac Center (Deutsches Kinderherzzentrum), Sankt Augustin, Germany.
Eur J Cardiothorac Surg. 2010 Jan;37(1):210-7. doi: 10.1016/j.ejcts.2009.06.037. Epub 2009 Jul 30.
The Aristotle basic complexity (ABC) score (1.5-15 points) is the sum of potentials for early mortality, morbidity and anticipated surgical technique difficulty. The Aristotle comprehensive complexity (ACC) score (1.5-25 points) is the sum of ABC score and patient-adjusted complexity score; it comprises six complexity levels. We used the ACC score to evaluate quality in surgical management of congenital heart disease.
Procedures performed in year 2002 and 2007 were analysed. Proportion of procedures requiring at least 1 week of stay in the intensive care unit was chosen as the marker of morbidity. We adopted threshold duration of 120 min for cardio-pulmonary bypass (CPB) cases and the same duration for operations without CPB as surrogate of surgical technical difficulty. The ACC scores were correlated to mortality, morbidity and technical difficulty.
This study included 758 patients who underwent 787 primary procedures. The mean ABC and ACC scores amounted to 7.61+/-2.46 and 9.51+/-3.84. Early mortality was 3.05% (24/787), 95% confidence interval (CI): 1.97-4.51%. Zero at ACC levels 1 and 2, it increased from 1.2% (2/161) for level 3 up to 22.2% (2/9) for level 6. Morbidity index was evaluated at 25.9% (204/787), 95% CI: 22.9-29.1%. 1.9% at level 1, it escalated up to 77.8% at level 6. Index of technique difficulty was estimated at 35.2% (277/787), 95% CI: 31.8-38.6%, ranging from 4.8% for level 1 to 66.7% for level 6. A high correlation was found between the ACC scores and mortality, indices of morbidity and technique difficulty, Spearman's correlation coefficient r being 0.9856, 1 and 0.9429, respectively. Mortality (p=0.037) and morbidity (p=0.041) were lower in year 2007 than in 2002 with ABC (p=0.18) and ACC (p=0.37) surgical performance being not significantly different.
The Aristotle score is still under development. Morbidity evaluation should be ideally based on observed postoperative complications; estimation of surgical technical difficulty chosen in this study may not be generalised. Nevertheless, the actual Aristotle comprehensive complexity score, as evaluated in its three components, accurately determined the outcome of surgical management of congenital heart disease. It appears to be an adequate tool to evaluate quality in paediatric cardiac surgery, over time.
亚里士多德基本复杂度（ABC）评分（1.5-15 分）是早期死亡率、发病率和预期手术技术难度的总和。亚里士多德综合复杂度（ACC）评分（1.5-25 分）是 ABC 评分和患者调整复杂度评分的总和；它包括六个复杂度级别。我们使用 ACC 评分来评估先天性心脏病手术管理的质量。
分析了 2002 年和 2007 年进行的手术。需要至少 1 周 ICU 住院的手术比例被选为发病率的标志物。我们采用 120 分钟的心肺转流术（CPB）时间作为 CPB 病例的手术技术难度替代指标，而无 CPB 手术的相同时间则作为手术技术难度的替代指标。ACC 评分与死亡率、发病率和技术难度相关。
这项研究包括 758 名接受 787 例原发性手术的患者。平均 ABC 和 ACC 评分为 7.61+/-2.46 和 9.51+/-3.84。早期死亡率为 3.05%（24/787），95%置信区间（CI）：1.97-4.51%。ACC 水平为 1 和 2 时为 0，从 3 级的 1.2%（2/161）上升到 6 级的 22.2%（2/9）。发病率指数评估为 25.9%（204/787），95%CI：22.9-29.1%。1.9%在 1 级，上升到 6 级的 77.8%。技术难度指数估计为 35.2%（277/787），95%CI：31.8-38.6%，从 1 级的 4.8%到 6 级的 66.7%。ACC 评分与死亡率、发病率和技术难度指数之间存在高度相关性，Spearman 相关系数 r 分别为 0.9856、1 和 0.9429。2007 年的死亡率（p=0.037）和发病率（p=0.041）低于 2002 年，ABC（p=0.18）和 ACC（p=0.37）手术表现无显著差异。
亚里士多德评分仍在开发中。发病率评估理想情况下应基于术后观察到的并发症；本研究选择的手术技术难度估计可能无法推广。然而，实际的亚里士多德综合复杂度评分，根据其三个组成部分进行评估，准确确定了先天性心脏病手术管理的结果。它似乎是评估儿科心脏手术质量的一个合适工具，随着时间的推移。
