[Predictive value of 3 different risk stratification models for patients after congenital heart surgeries].

Objective: To evaluate the predictive value of 3 different risk stratification models including the risk adjustment in congenital heart surgery-1 (RACHS-1), Aristotle basic complexity (ABC), and Society of Thoracic Surgeons-European Association for cardiothoracic surgery congenital heart surgery mortality score (STAT) risk scoring system for death and major complications in patients after congenital heart surgeries. Methods: A total of 3 578 patients (age<18 years old) received surgery for congenital heart diseases from January to December 2015 in Fuwai hospital were enrolled, and the clinical data were retrospectively analyzed. The congenital heart disease patients were 1.7 (0.8, 4.5) years old, and the male accounted for 54.3% (1 943 cases).Death after surgery and major complications including use of extracorporeal membrane oxygenation, bedside thoracotomy, peritoneal dialysis for renal failure, bedside hemofiltration for renal failure, tracheotomy, reoperation for mediastinum infection, reoperation for heart in hospital were observed. The area under the receiver operating characteristic (ROC) curve was calculated to evaluate the predictive value for mortality after surgery and major complications with RACHS-1, ABC, and STAT risk scoring systems. Results: The mortality after surgery was 0.4% (14/3 578) , and the rate of major complications was 3.2% (113/3 578) . For mortality after surgery, areas under the ROC curve were 0.682 (95%CI 0.570-0.795, P=0.002), 0.722 (95%CI 0.612-0.832, P<0.001), and 0.753 (95%CI 0.659-0.847, P<0.001) with RACHS-1, ABC and STAT risk scoring systems, respectively. For major complications, areas under the ROC curve were 0.709 (95%CI 0.667-0.751, P<0.001), 0.743 (95%CI 0.702-0.784, P<0.001), and 0.731 (95%CI 0.693-0.770, P<0.001) with RACHS-1, ABC and STAT risk scoring systems, respectively. Conclusion: STAT risk scoring system is superior to RACHS-1 and ABC risk scoring systems on predicting death after surgery, and ABC risk scoring system is superior to RACHS-1 and STAT risk scoring systems on predicting major complications in Chinese patients with congenital heart disease in the single center.目的： 比较先天性心脏病（先心病）手术风险分级评分（RACHS-1）、亚里士多德基本评分（ABC）和美国胸外科医师协会-欧洲胸心外科协会先心病手术死亡评分（STAT）3种手术风险评分系统对先心病患者手术死亡和重大并发症的预测效能。 方法： 纳入2015年1至12月在阜外医院接受手术的先心病患者（年龄<18岁）3 578例，对其临床资料进行回顾性分析。先心病患者年龄1.7（0.8，4.5）岁，男性患者占54.3%（1 943例）。观察先心病患者住院期间的手术死亡率和重大并发症（包括应用体外膜肺氧合、床旁开胸抢救、肾功能衰竭需腹膜透析、肾功能衰竭需床旁血液透析、气管切开、胸部切口感染需清创和再次手术）发生率，并采用受试者工作特征（ROC）曲线下面积评价RACHS-1、ABC和STAT 3种手术风险评分系统对先心病患者手术死亡和重大并发症的预测效能。 结果： 先心病患者手术死亡率为0.4%（14/3 578），重大并发症发生率为3.2%（113/3 578）。RACHS-1、ABC和STAT 3种先心病手术风险评分系统对手术死亡的预测效能分别是0.682（95%CI 0.570~0.795，P=0.002）、0.722（95%CI 0.612~0.832，P<0.001）和0.753（95%CI 0.659~0.847，P<0.001），对重大并发症的预测效能分别是0.709（95%CI 0.667~0.751，P<0.001）、0.743（95%CI 0.702~0.784，P<0.001）和0.731（95%CI 0.693~0.770，P<0.001）。 结论： 在单中心我国人群中，STAT手术风险评分系统对先心病患者手术死亡的预测效能优于RACHS-1和ABC手术风险评分系统；ABC手术风险评分系统对先心病患者手术后重大并发症的预测效能优于RACHS-1和STAT手术风险评分系统。.