Children’s Surgeons Lead Worldwide Project
from The Children's Hospital (TCH) News, June 2005
Surgeons from The Children’s Hospital Heart Institute are the first in the world to develop an electronic tool that ranks the complexity of more than 150 pediatric procedures for congenital heart disease.
Five years ago, pediatric cardiac surgeons began developing the tool after becoming frustrated that their surgical performance was evaluated based on hospital mortality without regard for the complexity of the operations performed, said David Clarke, MD, professor of surgery for the division of cardiothoracic surgery.
The evaluation of surgeons’ performance didn’t take into account a number of factors that can greatly influence outcome, Dr. Clarke said. 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.
Because there was no precedent for such a tool, the group decided to name it after Aristotle, who said, “When there is no scientific answer available, the opinion perceived and admitted by the majority has value of truth.”
The group first developed a basic procedure-scoring system “for the simplest version of a procedure and an optimal candidate,” he said.
Scores range from 1.5 to 15, he said – 1.5 for the lowest risk, and 15 for the highest.
Procedures such as those for VSDs and ASDs (atrial septal defect) are fairly simple to perform, Dr. Clarke said. But procedures such as the Norwood operation for Hypoplastic Left Heart Syndrome are much more complicated and have a score of 14.5.
This system was “a good start,” Dr. Clarke said.“But we understood these factors weren’t the whole story,” he said. “Not every patient has the basic form of the disease. Some have complications; sometimes we have to do more than one procedure.”
The second part of the tool ranks such factors as atypical anatomy, the need for additional associated procedures, and the effects of age, low birth weight or other diseases, Dr. Clarke said. These factors add another 10 possible points to the score, making the highest possible score 25.
The Aristotle tool, available at www.aristotleinstitute.org, will allow surgeons to input the procedure and other factors for a fee to get a score from 1.5 to 25. In addition, Dr. Clarke said, cardiologists will be able to help parents determine their child’s score and develop a list of institutions capable of performing procedures with that complexity.
The group has applied for a $1.5 million grant to develop 3-D animation for the web site to provide visual aids, he said. Parents and surgeons soon will be able to view lifelike animation of the anatomy of a child’s disease and of the procedure to correct it.
The tool, which has been distributed to more than 20 centers worldwide, also will become part of an online data repository, Dr. Clarke said.“Ultimately, centers from around the world will input data into a secure site and get real-time updating of scores,” he said. “We will be able to collect data for comparison, which will lend the score more credibility.”
