Aristotle Comprehensive Complexity (ACC) Score: Explanation and Clinical Context
The ACC Score is designed to quantify the overall surgical complexity in congenital heart surgery by combining the Aristotle Basic Complexity (ABC) score with procedure-dependent modifiers and patient-dependent modifiers. The ABC score (range ~1.5 to 15) itself is derived from three domains: potential mortality, potential morbidity, and technical difficulty. The additional modifiers (each up to 5 points) allow adjustment for anatomical variations, associated procedures, comorbidities, or other patient-specific risk factors — thus achieving a more refined complexity index (total scale up to ~25). Empirical validation in cohorts has shown that ACC correlates with short-term mortality (c-index ~0.86) and ICU stay (especially within first postoperative week). It is often used in comparative outcomes research or institutional benchmarking, under the conceptual framework Performance = Complexity × Outcome