Development of a diagnosis- and procedure-based risk model for 30-day outcome after pediatric cardiac surgery Sonya Crowe, PhD, Kate L. Brown, MPH, MRCP,

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Development of a diagnosis- and procedure-based risk model for 30-day outcome after pediatric cardiac surgery Sonya Crowe, PhD, Kate L. Brown, MPH, MRCP, Christina Pagel, PhD, Nagarajan Muthialu, FRCS, David Cunningham, PhD, John Gibbs, FRCP, Catherine Bull, MRCP, Rodney Franklin, MD, FRCP, Martin Utley, PhD, Victor T. Tsang, MD, FRCS The Journal of Thoracic and Cardiovascular Surgery Volume 145, Issue 5, Pages 1270-1278 (May 2013) DOI: 10.1016/j.jtcvs.2012.06.023 Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Observed 30-day mortality for specific procedures in the development set (circles) and validation set (crosses). The numbers (n) of episodes for each specific procedure in the development set are listed. The low-volume specific procedure group includes aortic root replacement (not Ross), aortopulmonary window repair, atrioventricular septal defect and tetralogy repair, cor triatriatum repair, multiple ventricular septal defect closure, Senning or Mustard procedure, tetralogy with absent pulmonary valve repair, tricuspid valve replacement, and truncus and interruption repair. The vertical lines denote the mean 30-day mortality in the development set (black) and validation set (grey dashed): Note that these are almost identical. Data are ordered in decreasing 30-day mortality for the development set. Note that the Rastelli procedure is defined as an intraventricular left ventricle to aorta tunnel and right ventricle to pulmonary artery conduit. VSD, Ventricular septal defect; PDA, patent ductus arteriosus; AVR, aortic valve replacement; ASD, atrial septal defect. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 1270-1278DOI: (10.1016/j.jtcvs.2012.06.023) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Cumulative deaths among the entire validation set plotted against episode number with episodes ordered by increasing risk as predicted by the risk model. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 1270-1278DOI: (10.1016/j.jtcvs.2012.06.023) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Receiver operating characteristic curve for 3 models evaluated in the validation set: the final risk model (C-index = 0.77), a model based solely on specific procedure (C-index = 0.72), and a model based on all factors in the final model except specific procedure (C-index of 0.74). The Journal of Thoracic and Cardiovascular Surgery 2013 145, 1270-1278DOI: (10.1016/j.jtcvs.2012.06.023) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Performance of the model in the validation set for all episodes occurring after January 1, 2007. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 1270-1278DOI: (10.1016/j.jtcvs.2012.06.023) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions