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The Aristotle score: a complexity-adjusted method to evaluate surgical results.

机译:亚里士多德评分:一种评估手术结果的复杂度调整方法。

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摘要

Objectives: Quality control is difficult to achieve in Congenital Heart Surgery (CHS) because of the diversity of the procedures. It is particularly needed, considering the potential adverse outcomes associated with complex cases. The aim of this project was to develop a new method based on the complexity of the procedures. Methods: The Aristotle project, involving a panel of expert surgeons, started in 1999 and included 50 pediatric surgeons from 23 countries, representing the EACTS, STS, ECHSA and CHSS. The complexity was based on the procedures as defined by the STS/EACTS International Nomenclature and was undertaken in two steps: the first step was establishing the Basic Score, which adjusts only the complexity of the procedures. It is based on three factors: the potential for mortality, the potential for morbidity and the anticipated technical difficulty. A questionnaire was completed by the 50 centers. The second step was the development of the Comprehensive Aristotle Score, which further adjuststhe complexity according to the specific patient characteristics. It includes two categories of complexity factors, the procedure dependent and independent factors. After considering the relationship between complexity and performance, the Aristotle Committee is proposing that: Performance=ComplexityxOutcome. Results: The Aristotle score, allows precise scoring of the complexity for 145 CHS procedures. One interesting notion coming out of this study is that complexity is a constant value for a given patient regardless of the center where he is operated. The Aristotle complexity score was further applied to 26 centers reporting to the EACTS congenital database. A new display of centers is presented based on the comparison of hospital survival to complexity and to our proposed definition of performance. Conclusion: A complexity-adjusted method named the Aristotle Score, based on the complexity of the surgical procedures has been developed by an international group of experts. The Aristotle score, electronicallyavailable, was introduced in the EACTS and STS databases. A validation process evaluating its predictive value is being developed.
机译:目的:由于程序的多样性,在先天性心脏手术(CHS)中很难实现质量控制。考虑到与复杂案例相关的潜在不良后果,特别需要这样做。该项目的目的是根据程序的复杂性开发一种新方法。方法:亚里士多德项目由专家外科医生小组组成,始于1999年,包括来自23个国家的50名儿科外科医生,代表了EACTS,STS,ECHSA和CHSS。复杂度基于STS / EACTS国际术语所定义的程序,分两个步骤进行:第一步是建立基本评分,仅对程序的复杂度进行调整。它基于三个因素:死亡的可能性,发病的可能性和预期的技术难度。 50个中心完成了调查表。第二步是开发全面的亚里士多德评分,该评分会根据患者的具体特征进一步调整复杂性。它包括两类复杂性因素:程序相关因素和独立因素。在考虑了复杂性和性能之间的关系之后,亚里斯多德委员会提议:Performance = ComplexityxOutcome。结果:亚里士多德(Aristotle)评分可以对145 CHS手术的复杂性进行精确评分。这项研究得出的一个有趣的观点是,对于给定的患者,复杂度是一个恒定值,而与他在何处进行手术无关。亚里士多德复杂性评分进一步应用于向EACTS先天性数据库报告的26个中心。基于医院生存率与复杂性以及我们提出的绩效定义的比较,提出了一个新的中心展示。结论:一个由国际专家组成的小组根据外科手术的复杂性,开发了一种称为Aristotle Score的复杂度调整方法。电子可用的亚里斯多德分数在EACTS和STS数据库中引入。正在开发评估其预测价值的验证过程。

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