Validation of Risk Stratification Methods for Congenital Heart Disease Surgery in Mexico: RACHS-1 and Aristotle Scales

Abstract

Background: Currently, it has two methods of risk stratification in Congenital Heart surgery: Risk Adjustment in Congenital Heart Surgery(RACHS-1) and the complex integral Aristotelian (Aristotle). Although they have been tested in different countries, they have not been validated in hospitals of Mexico. Objectives: Validating both methods at 3rd Level Hospital (Cardiology Hospital CMN-SXXI, IMSS, Mexico City) for patients submitted to cardiac surgery due to congenital heart defects, between January 2015 and December 2016. Methods: A retrospective study of patients in the Hospital’s cardiology of the National Medical Center C-XXI, IMSS-Mexico, of any age and gender undergoing surgery for congenital heart disease elective or emergency with clinical record is prepared full. For studying validity, internal consistency, calibration, capacity for discrimination and morbidity and mortality between the risk levels were analyzed. Results: We included 201 patients with complete data. Both study scales in our study were statistically significant in the Logistic regression analysis (p = 0.001 and p = 0.000, respectively). Calibration test show to be non-significant for both scales (X2 of Hosmer-Lemeshow of 0.357 and 3.235 respectively). The areas under the ROC curve were 0.770 and 0.806, respectively, suggesting a good discrimination. The observed mortality was (6.46%). Nevertheless, each segment of the scales exceeded the expected in mortality according to the internationally accepted parameters for RACHS-1. Conclusion: We conclude that it is valid to use RACHS-1 and basic Aristotle for surgery of congenital heart disease, with a Cronbach’s alpha of 0.740. We suggested developing mechanisms to understand those variables that come out of the control of these instruments, such as the patient’s low weight and a history of reoperation. Key words: surgical risk; congenital heart disease; RACHS-1; Aristotle