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American Academy of Pediatrics
Article

Risk Adjustment for Neonatal Surgery: A Method for Comparison of In-Hospital Mortality

Craig W. Lillehei, Kimberlee Gauvreau and Kathy J. Jenkins
Pediatrics September 2012, 130 (3) e568-e574; DOI: https://doi.org/10.1542/peds.2011-3647
Craig W. Lillehei
Departments of aSurgery, and
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Kimberlee Gauvreau
bCardiology, Children’s Hospital Boston, Boston, Massachusetts
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Kathy J. Jenkins
bCardiology, Children’s Hospital Boston, Boston, Massachusetts
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Abstract

OBJECTIVE: To develop a risk-adjustment method for evaluation of in-hospital mortality after noncardiac neonatal surgery regardless of gestational age.

METHODS: Infants ≤30 days old undergoing noncardiac surgical procedures were identified by using the Kids’ Inpatient Database (KID) 2000 + 2003. Neonates were included regardless of gestational age. International Classification of Disease, Ninth Revision, Clinical Modification codes were used to assign procedures to 1 of 4 previously derived risk categories. Prematurity and other clinical variables were assessed in logistic regression analysis. The final multivariable model was validated in 3 independent data sets: KID 2006, Pediatric Health Information System (PHIS) 2001–2003, and PHIS 2006–2008. The model was applied to generate standardized mortality ratios for institutions within PHIS 2006–2008.

RESULTS: Among 18 437 eligible cases in KID 2000 + 2003, 15 278 (83%) had 1 of 66 procedure codes assigned to a risk category and were eligible for analysis. In-hospital mortality for premature infants was 10.5% compared with 2.0% for full-term neonates. In addition to risk category, the clinical variables improving prediction of in-hospital death were prematurity, serious respiratory conditions, necrotizing enterocolitis, neonatal sepsis, and congenital heart disease. Area under the receiver-operator characteristic curve for the final model was 0.90. The model also showed excellent discrimination in the 3 validation data sets (0.90, 0.89, and 0.89). Within 41 institutions in PHIS, standardized mortality ratios ranged from 0.37 to 1.91.

CONCLUSIONS: This validated method provides a tool for risk adjustment of neonates undergoing noncardiac surgery to allow comparative analyses of in-hospital mortality.

KEY WORDS
  • risk adjustment
  • hospital mortality
  • neonatal surgery
  • term birth
  • premature birth
  • Abbreviations:
    CHD —
    congenital heart disease
    CI —
    confidence interval
    ICD-9-CM —
    International Classification of Disease, Ninth Revision, Clinical Modification
    KID —
    Kids’ Inpatient Database
    NEC —
    necrotizing enterocolitis
    OR —
    odds ratio
    PHIS —
    Pediatric Health Information System
    ROC —
    receiver-operator characteristic
    SMR —
    standardized mortality ratio
    • Accepted May 10, 2012.
    • Copyright © 2012 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 130, Issue 3
    1 Sep 2012
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    Risk Adjustment for Neonatal Surgery: A Method for Comparison of In-Hospital Mortality
    Craig W. Lillehei, Kimberlee Gauvreau, Kathy J. Jenkins
    Pediatrics Sep 2012, 130 (3) e568-e574; DOI: 10.1542/peds.2011-3647

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    Risk Adjustment for Neonatal Surgery: A Method for Comparison of In-Hospital Mortality
    Craig W. Lillehei, Kimberlee Gauvreau, Kathy J. Jenkins
    Pediatrics Sep 2012, 130 (3) e568-e574; DOI: 10.1542/peds.2011-3647
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