Evaluating Outcomes with a Consideration Toward Complexity

The Division of Surgery at The Children’s Hospital is a key player in an international movement to develop evaluation tools for surgical performance. The evaluation of surgeons’ performance didn’t take into account a number of factors that can greatly influence outcome. For example, a patient with a Ventricular Septal Defect, or a hole in the wall that separates the right and left sides of the heart, could have other complicating factors, such as heart valve involvement, lung problems, Down Syndrome or kidney disease, that make carrying out the procedure more difficult. A group of 50 congenital heart surgeons from 23 countries, led by Francois Lacour-Gayet, MD, and Dr. Clarke, decided to develop a method – called the Aristotle Score – adapted to their specialty.

The motivation behind the Complexity Score Project was a growing frustration of pediatric cardiac surgeons over the fact that their surgical performance was being evaluated based on hospital mortality, without regard for the complexity of the operations performed. A group of 50 internationally accepted experts has been working for more than five years on a new method to evaluate the quality of care in congenital heart surgery.

The complexity of a procedure has been quantified by a group of international experts representing 50 prominent international centers. Complexity is determined by assessing operative mortality, morbidity and difficulty of surgical technique. In the process of developing a practical formula for assessing surgical performance, the international physician group is also working to standardize nomenclature throughout the world and create an international registry database.

The Aristotle system, electronically available, has been introduced by both the European Association for Cardio-Thoracic Surgery (EACTS) and Society of Thoracic Surgeons (STS) as an original method to compare the performance of Congenital Heart Surgery (CHS) centers. Pediatric cardiologists have joined the project and are currently developing a complexity score for interventional cardiology procedures. Aristotle Complexity Scoring will aid surgeons in preoperative patient evaluation, assessing protocols and improving outcomes based on the complexity of the patients treated. Aristotle Scoring will broaden our ability to share data. By combining statistical analysis with the knowledge and experience gained in the operating room, we can expedite medical progress and improve outcomes for our young patients.