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François Lacour-Gayet
Marshall L. Jacobs
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Constantine Mavroudis
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Ann Thorac Surg 2007;84:1-2
© 2007 The Society of Thoracic Surgeons

Editorial

The Need for an Objective Evaluation of Morbidity in Congenital Heart Surgery

François Lacour-Gayet, MDa,*, Marshall L. Jacobs, MDb, Jeffrey P. Jacobs, MDc, Constantine Mavroudis, MDd

a The Children’s Hospital, University of Colorado, Denver, Colorado
b St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania
c The Congenital Heart Institute of Florida, University of South Florida, St. Petersburg, Florida
d Children’s Memorial Hospital, Northwestern University, Chicago, Illinois

* Address correspondence to Dr Lacour-Gayet, Denver Children’s Hospital, University of Colorado, 1056 E 19th Ave, Denver, CO 80218 (Email: lacour-gayet.francois@tchden.org).

The first 20% of the full text of this article appears below.

Today the evaluation of quality of care in congenital heart surgery is essentially based on operative mortality, which stands at 4% to 5%, ignoring the potential operative morbidity occurring in the discharged patients (95%). In this volume of The Annals of Thoracic Surgery, Benavidez and colleagues [1] address the important and controversial issue of morbidity evaluation in congenital heart surgery. Clearly a system of identifying, classifying, and quantifying complications associated with surgery for congenital heart disease is an essential ingredient of outcome assessment, performance evaluation, and quality improvement. In their investigation of the potential relationship between complications and mortality, Benavidez and his associates [1] have chosen to start by using data from the Kids’ Inpatient Database (KID) 2000. As a result, their analysis suffers from all of the limitations of a data set characterized by the "vagaries" and errors that have been shown to occur when administrative data based upon ICD9 and CPT9 codes is entered by nonclinicians. Despite its high volume, the KID database remains a nonvalidated administrative database. The data are usually not entered by physicians or nurses, but are essentially entered by administrative staff in charge of financial coding.

The poor accuracy of the ICD9 and CPT9 coding for congenital heart disease and surgery has led The . . . [Full Text of this Article]


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