Cavalcanti Paulo Ernando Ferraz, Sá Michel Pompeu Barros de Oliveira, Santos Cecília Andrade dos, Esmeraldo Isaac Melo, Chaves Mariana Leal, Lins Ricardo Felipe de Albuquerque, Lima Ricardo de Carvalho
Universidade de Pernambuco, Recife, PE, Brazil.
Rev Bras Cir Cardiovasc. 2015 Mar-Apr;30(2):148-58. doi: 10.5935/1678-9741.20150001.
To determine whether stratification of complexity models in congenital heart surgery (RACHS-1, Aristotle basic score and STS-EACTS mortality score) fit to our center and determine the best method of discriminating hospital mortality.
Surgical procedures in congenital heart diseases in patients under 18 years of age were allocated to the categories proposed by the stratification of complexity methods currently available. The outcome hospital mortality was calculated for each category from the three models. Statistical analysis was performed to verify whether the categories presented different mortalities. The discriminatory ability of the models was determined by calculating the area under the ROC curve and a comparison between the curves of the three models was performed.
360 patients were allocated according to the three methods. There was a statistically significant difference between the mortality categories: RACHS-1 (1) - 1.3%, (2) - 11.4%, (3)-27.3%, (4) - 50 %, (P<0.001); Aristotle basic score (1) - 1.1%, (2) - 12.2%, (3) - 34%, (4) - 64.7%, (P<0.001); and STS-EACTS mortality score (1) - 5.5 %, (2) - 13.6%, (3) - 18.7%, (4) - 35.8%, (P<0.001). The three models had similar accuracy by calculating the area under the ROC curve: RACHS-1- 0.738; STS-EACTS-0.739; Aristotle- 0.766.
The three models of stratification of complexity currently available in the literature are useful with different mortalities between the proposed categories with similar discriminatory capacity for hospital mortality.
确定先天性心脏病手术复杂性模型分层（RACHS - 1、亚里士多德基本评分和STS - EACTS死亡率评分）是否适用于我们中心，并确定区分医院死亡率的最佳方法。
将18岁以下先天性心脏病患者的手术程序分配到当前可用的复杂性分层方法所提出的类别中。从这三个模型计算每个类别的医院死亡率结局。进行统计分析以验证各分类的死亡率是否不同。通过计算ROC曲线下面积来确定模型的辨别能力，并对三个模型的曲线进行比较。
根据三种方法分配了360例患者。死亡率类别之间存在统计学显著差异：RACHS - 1（1）-1.3%，（2）-11.4%，（3）-27.3%，（4）-50%，（P<0.001）；亚里士多德基本评分（1）-1.1%，（2）-12.2%，（3）-34%，（4）-64.7%，（P<0.001）；以及STS - EACTS死亡率评分（1）-5.5%，（2）-13.6%，（3）-18.7%，（4）-35.8%，（P<0.001）。通过计算ROC曲线下面积，这三个模型具有相似的准确性：RACHS - 1为0.738；STS - EACTS为0.739；亚里士多德为0.766。
文献中目前可用的三种复杂性分层模型都很有用，所提出的类别之间死亡率不同，但对医院死亡率具有相似的辨别能力。
