The Aristotle Comprehensive Complexity Score Predicts Mortality and Morbidity After Congenital Heart Surgery Mirela Bojan, MD, MS, Sébastien Gerelli,

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The Aristotle Comprehensive Complexity Score Predicts Mortality and Morbidity After Congenital Heart Surgery Mirela Bojan, MD, MS, Sébastien Gerelli, MD, Simone Gioanni, MD, Philippe Pouard, MD, Pascal Vouhé, MD, PhD The Annals of Thoracic Surgery Volume 91, Issue 4, Pages 1214-1221 (April 2011) DOI: 10.1016/j.athoracsur.2010.10.071 Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Estimated relationship between the Aristotle Comprehensive Complexity (ACC) score and the log-odds ratios (OR) for 30-day mortality. Solid line is a spline fit, knots are marked with arrows. Thirty-day mortality was strongly related to the Aristotle Comprehensive Complexity score. (CI = confidence interval.) The Annals of Thoracic Surgery 2011 91, 1214-1221DOI: (10.1016/j.athoracsur.2010.10.071) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Calibration curve of the regression model describing 30-day mortality as a function of the Aristotle Comprehensive Complexity score. Overall calibration was good, predicted mortality was overestimated for high actual mortality rates. The bias-corrected curve was constructed by bootstrap estimates. Triangles represent the actual mortality rate within deciles of the predicted mortality rate, a graphic illustration of the Hosmer-Lemeshow goodness-of-fit test. Rug plot at the top of the graph indicates the distribution of predicted probabilities. The Annals of Thoracic Surgery 2011 91, 1214-1221DOI: (10.1016/j.athoracsur.2010.10.071) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Receiver operating characteristics curve illustrating the discrimination accuracy of the Aristotle Comprehensive Complexity score for 30-day mortality. The c index was 0.864, bootstrap calculated 95% confidence intervals were 0.819 to 0.906. The Annals of Thoracic Surgery 2011 91, 1214-1221DOI: (10.1016/j.athoracsur.2010.10.071) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Odds ratio (OR) for 30-day mortality within the levels of the Aristotle Comprehensive Complexity (ACC) score. Odds ratios are shown with 95% confidence intervals (CI). The first, second, and third level were combined into a composite level for analysis. Breslow-Day statistics show a linear trend (χ2 = 3.37; df, 3; p = 0.337). The Annals of Thoracic Surgery 2011 91, 1214-1221DOI: (10.1016/j.athoracsur.2010.10.071) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Interval-specific log-hazard ratios (HR) of Aristotle Comprehensive Complexity score for the length of intensive care unit (ICU) stay. Length of intensive care unit stay was strongly related to the Aristotle Comprehensive Complexity score during the first postoperative week. (CI = confidence interval.) The Annals of Thoracic Surgery 2011 91, 1214-1221DOI: (10.1016/j.athoracsur.2010.10.071) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Calibration curve for the Cox model describing the length of the intensive care unit (ICU) stay as a function of the Aristotle score. Overall calibration of the model was good, but predicted length of stay was overestimated for short actual length of stay. Validation of the calibration curve was performed by bootstrap repeat sampling in six prognostic groups. Dots represent the apparent predictions for each group, X's represent bootstrap-corrected estimates. The Annals of Thoracic Surgery 2011 91, 1214-1221DOI: (10.1016/j.athoracsur.2010.10.071) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions