RACHS-1 (Congenital Heart Surgery Risk Category)
RACHS-1, the Risk Adjustment for Congenital Heart Surgery (Jenkins and colleagues 2002).
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Example
- The RACHS-1 category of the procedure performed
- 4
- Age at surgery
- Age at surgery 30 days or less
- Prematurity?
- Yes
- Major non-cardiac structural anomaly?
- No
Result: RACHS-1 category 4.
The tool opens with these values already filled in. Replace them with your own.
What the result means
- Category 1
- Derivation-cohort in-hospital mortality 0.4 percent. Secundum ASD repair, PDA closure over 30 days, coarctation repair over 30 days.
- Category 2
- 3.8 percent. VSD repair, tetralogy repair, Glenn shunt, coarctation repair at 30 days or less.
- Category 3
- 8.5 percent. Arterial switch, Fontan, complete AVSD repair, aortic valve replacement, systemic-to-pulmonary shunt.
- Category 4
- 19.4 percent. Rastelli, truncus repair, interrupted arch repair, aortic valvuloplasty at 30 days or less.
- Category 5
- NO mortality estimate was published: too few cases. Kept as its own category, judged higher risk than 4 and lower than 6.
- Category 6
- 47.7 percent. Norwood operation.
- Modifiers
- Age 30 days or less odds ratio about 3.0, 31 days to 1 year about 1.9, prematurity about 1.8, major non-cardiac anomaly about 1.8. These multiply risk; they are not points.
What you enter
- The RACHS-1 category of the procedure performed.
- Age at surgery - a SEPARATE adjusted odds ratio, not a point added to the category
- Prematurity?
- Major non-cardiac structural anomaly?
Full field descriptions
- The RACHS-1 category of the procedure performed. Examples are REPRESENTATIVE, not exhaustive [1: Secundum atrial septal defect repair; patent ductus arteriosus closure over 30 days of age; coarctation repair over 30 days of age; partial anomalous pulmonary venous return repair; aortopexy. 2: Ventricular septal defect repair; tetralogy of Fallot repair; primum atrial septal defect repair; Glenn shunt; pulmonary valvuloplasty or replacement; coarctation repair at 30 days or less; total anomalous pulmonary venous return repair over 30 days; vascular ring surgery. 3: Arterial switch operation; atrial switch operation; Fontan procedure; complete atrioventricular septal defect repair; aortic valve replacement or Ross procedure; mitral or tricuspid valve replacement; right ventricle to pulmonary artery conduit; systemic-to-pulmonary artery shunt; pulmonary artery banding. 4: Aortic valvuloplasty at 30 days or less; Konno procedure; Rastelli procedure; truncus arteriosus repair; interrupted aortic arch repair with or without ventricular septal defect repair; total anomalous pulmonary venous return repair at 30 days or less; arterial switch with ventricular septal defect closure; unifocalization for tetralogy with pulmonary atresia. 5: Tricuspid valve repositioning for neonatal Ebstein anomaly at 30 days or less; truncus arteriosus repair with interrupted aortic arch repair. Only two procedures are assigned here. 6: Norwood operation.]
- Age at surgery - a SEPARATE adjusted odds ratio, not a point added to the category [age<=30d = Age at surgery 30 days or less, odds ratio about 3; age31d-1y = Age at surgery 31 days to 1 year, odds ratio about 1.9; age>1y = Age at surgery over 1 year (the reference), odds ratio about 1]
- Prematurity? A separate adjusted odds ratio of about 1.8, not a point added to the category.
- Major non-cardiac structural anomaly? A separate adjusted odds ratio of about 1.8, not a point added to the category.
How this is calculated
Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg. 2002;123(1):110-118. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.