{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T03:10:55Z","timestamp":1788491455864,"version":"build-2803163510"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Department of Health and Social Care\u2019s Policy Research Programme","award":["PR-R20-0318-23001"],"award-info":[{"award-number":["PR-R20-0318-23001"]}]},{"name":"National Institute for Health Research Academic Clinical Fellowship","award":["ACF-2022-18-017"],"award-info":[{"award-number":["ACF-2022-18-017"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>As postoperative mortality for paediatric cardiac surgery is very low, we aimed to develop methods for monitoring of postoperative complication rates, given their impact upon children\u2019s health and well-being.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We used national registry data to develop and evaluate a suite of risk adjustment models for the outcomes of 6 defined postoperative complications, designed for use in complication monitoring for quality assurance.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There were 23\u2009423 30-day postoperative episodes in children under the age of 18 years undergoing cardiac surgery between 2015 and 2021 in England and Wales, with 361 (1.5%) deaths &amp;lt;30 days. Two hundred fifty-seven (1.9%) of 13\u2009556 postoperative episodes in infants (&amp;lt;1 year) involved necrotizing enterocolitis; 158 (1.3%) of 12\u2009408 postoperative episodes between 2018 and 2021 involved prolonged pleural effusion; and among the full sample of postoperative episodes, there were 526 (2.2%) acute neurological events, 446 (1.9%) extracorporeal life supports, 740 (3.6%) renal replacement therapies, and 1006 (4.3%) unplanned reinterventions within 30 days of surgery. The risk adjustment models were developed using clinical factors first defined for mortality monitoring. The models for prolonged pleural effusion, extracorporeal life support, and renal replacement performed very well with area under the curve (AUC) statistics &amp;gt;0.85. The performance of the models for necrotizing enterocolitis, acute neurological event, and unplanned reintervention was less good (AUC statistics 0.74-0.79).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Although complications are more complex outcome measures than mortality, national registry data can be used to capture them and to evaluate methods for risk adjustment of these outcomes. These methods may enable future risk-adjusted monitoring of complication metrics for quality assurance.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezaf317","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T13:18:01Z","timestamp":1758892681000},"source":"Crossref","is-referenced-by-count":2,"title":["Risk Models for Monitoring Postoperative Complication Rates After Paediatric Cardiac Surgery"],"prefix":"10.1093","volume":"67","author":[{"given":"Hannah K","family":"Mitchell","sequence":"first","affiliation":[{"name":"Infection, Immunity and Inflammation Department, University College London (UCL) Institute of Child Health , London, WC1N 1EH,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9085-7400","authenticated-orcid":false,"given":"Ferran","family":"Espuny-Pujol","sequence":"additional","affiliation":[{"name":"Clinical Operational Research Unit, UCL , London, WC1H OBT,","place":["United Kingdom"]},{"name":"Department of Computer Science, University of Reading , Reading, RG6 6UR,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney C","family":"Franklin","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Department, Royal Brompton and Harefield NHS Foundation Trust , London, SW3 6NP,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5322-7327","authenticated-orcid":false,"given":"Gareth","family":"Ambler","sequence":"additional","affiliation":[{"name":"Department of Statistical Science, UCL , London, WC1E 6BT,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Stickley","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Birmingham Women\u2019s and Children\u2019s NHS Foundation Trust , Birmingham, B4 6NH,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7698-6991","authenticated-orcid":false,"given":"Julie A","family":"Taylor","sequence":"additional","affiliation":[{"name":"Clinical Operational Research Unit, UCL , London, WC1H OBT,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2721-3279","authenticated-orcid":false,"given":"Carin","family":"Van Doorn","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiac Surgery, Leeds General Infirmary , Leeds, LS1 3EX,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5063-4112","authenticated-orcid":false,"given":"Serban","family":"Stoica","sequence":"additional","affiliation":[{"name":"Paediatric Cardiac Surgery, Bristol Heart Institute , Bristol, BS2 8BJ,","place":["United 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