Objective

Current risk adjustment models for congenital heart surgery do not fully incorporate multiple factors unique to neonates such as granular gestational age (GA) and birth weight (BW) z score data. This study sought to develop a Neonatal Risk Adjustment Model for congenital heart surgery to address these deficiencies.

Methods

Cohort study of neonates undergoing cardiothoracic surgery during the neonatal period captured in the Pediatric Cardiac Critical Care Consortium database between 2014 and 2020. Candidate predictors were included in the model if they were associated with mortality in the univariate analyses. GA and BW z score were both added as multicategory variables. Mortality probabilities were predicted for different GA and BW z scores while keeping all other variables at their mean value.

Results

The C statistic for the mortality model was 0.8097 (95% confidence interval, 0.7942-0.8255) with excellent calibration. Mortality prediction for a neonate at 40 weeks GA and a BW z score 0 to 1 was 3.5% versus 9.8% for the same neonate at 37 weeks GA and a BW z score −2 to −1. For preterm infants the mortality prediction at 34 to 36 weeks with a BW z score 0 to 1 was 10.6%, whereas it was 36.1% for the same infant at <32 weeks with a BW z score of −2 to −1.

Conclusions

This Neonatal Risk Adjustment Model incorporates more granular data on GA and adds the novel risk factor BW z score. These 2 factors refine mortality predictions compared with traditional risk models. It may be used to compare outcomes across centers for the neonatal population.

中文翻译：

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胎儿生长和胎龄改善新生儿心脏手术的结果预测

客观的

目前的先天性心脏手术风险调整模型并未完全纳入新生儿特有的多种因素，例如颗粒胎龄 (GA) 和出生体重 (BW) z评分数据。本研究旨在为先天性心脏手术开发新生儿风险调整模型，以解决这些缺陷。

方法

对 2014 年至 2020 年儿科心脏重症监护联盟数据库中捕获的新生儿期接受心胸外科手术的新生儿进行队列研究。如果候选预测因子与单变量分析中的死亡率相关，则将其纳入模型。GA 和 BW z分数都作为多类别变量添加。预测不同 GA 和 BW z分数的死亡率概率，同时将所有其他变量保持在其平均值。

结果

死亡率模型的C统计量为 0.8097（95% 置信区间，0.7942-0.8255），具有出色的校准。GA 40 周和 BW z评分为 0 到 1 的新生儿的死亡率预测为 3.5%，而 GA 37 周和 BW z评分为-2 到-1 的同一新生儿的死亡率为 9.8%。对于早产儿，34 至 36 周时 BW z评分为 0 至 1 的死亡率预测为 10.6%，而同一婴儿在 <32 周时 BW z评分为 -2 至 -1 的死亡率为 36.1%。

结论

这种新生儿风险调整模型结合了更精细的 GA 数据，并添加了新的风险因素 BW z评分。与传统风险模型相比，这 2 个因素改进了死亡率预测。它可用于比较新生儿人群各中心的结果。