Department of Pediatric Cardiac Anesthesiology, Necker Hospital, Paris, France.
Ann Thorac Surg. 2011 Apr;91(4):1214-21. doi: 10.1016/j.athoracsur.2010.10.071.
The Aristotle Comprehensive Complexity (ACC) score has been proposed for complexity adjustment in the analysis of outcome after congenital heart surgery. The score is the sum of the Aristotle Basic Complexity score, largely used but poorly related to mortality and morbidity, and of the Comprehensive Complexity items accounting for comorbidities and procedure-specific and anatomic variability. This study aims to demonstrate the ability of the ACC score to predict 30-day mortality and morbidity assessed by the length of the intensive care unit (ICU) stay.
We retrospectively enrolled patients undergoing congenital heart surgery in our institution. We modeled the ACC score as a continuous variable, mortality as a binary variable, and length of ICU stay as a censored variable. For each mortality and morbidity model we performed internal validation by bootstrapping and assessed overall performance by R(2), calibration by the calibration slope, and discrimination by the c index.
Among all 1,454 patients enrolled, 30-day mortality rate was 3.4% and median length of ICU stay was 3 days. The ACC score strongly related to mortality, but related to length of ICU stay only during the first postoperative week. For the mortality model, R(2) = 0.24, calibration slope = 0.98, c index = 0.86, and 95% confidence interval was 0.82 to 0.91. For the morbidity model, R(2) = 0.094, calibration slope = 0.94, c index = 0.64, and 95% confidence interval was 0.62 to 0.66.
The ACC score predicts 30-day mortality and length of ICU stay during the first postoperative week. The score is an adequate tool for complexity adjustment in the analysis of outcome after congenital heart surgery.
亚里士多德综合复杂性（ACC）评分已被提议用于分析先天性心脏病手术后的结果，以进行复杂性调整。该评分是亚里士多德基本复杂性评分的总和，该评分虽然广泛使用，但与死亡率和发病率相关性差，以及综合复杂性项目，这些项目与合并症以及程序特异性和解剖变异性有关。本研究旨在证明 ACC 评分预测 30 天死亡率和发病率的能力，这是通过 ICU 住院时间长短来评估的。
我们回顾性地招募了在我们机构接受先天性心脏病手术的患者。我们将 ACC 评分建模为连续变量，将死亡率建模为二分类变量，并将 ICU 住院时间建模为删失变量。对于每个死亡率和发病率模型，我们通过自举进行内部验证，并通过 R²评估整体性能，通过校准斜率评估校准，通过 C 指数评估区分度。
在所有纳入的 1454 名患者中，30 天死亡率为 3.4%，ICU 住院时间中位数为 3 天。ACC 评分与死亡率密切相关，但仅在术后第一周与 ICU 住院时间相关。对于死亡率模型，R²=0.24，校准斜率=0.98，C 指数=0.86，95%置信区间为 0.82 至 0.91。对于发病率模型，R²=0.094，校准斜率=0.94，C 指数=0.64，95%置信区间为 0.62 至 0.66。
ACC 评分可预测 30 天死亡率和术后第一周 ICU 住院时间。该评分是先天性心脏病手术后结果分析中用于复杂性调整的一种合适工具。
