Journal article
The complex relationship between pediatric cardiac surgical case volumes and mortality rates in a national clinical database
The Journal of thoracic and cardiovascular surgery, v 137(5), pp 1133-1140
01 May 2009
PMID: 19379979
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Objective: We sought to determine the association between pediatric cardiac surgical volume and mortality using sophisticated case-mix adjustment and a national clinical database.
Methods: Patients 18 years of age or less who had a cardiac operation between 2002 and 2006 were identified in the Society of Thoracic Surgeons Congenital Heart Surgery Database (32,413 patients from 48 programs). Programs were grouped by yearly pediatric cardiac surgical volume (small, <150; medium, 150-249; large, 250-349; and very large, >= 350 cases per year). Logistic regression was used to adjust mortality rates for volume, surgical case mix (Aristotle Basic Complexity and Risk Adjustment for Congenital Heart Surgery, Version 1 categories), patient risk factors, and year of operation.
Results: With adjustment for patient-level risk factors and surgical case mix, there was an inverse relationship between overall surgical volume as a continuous variable and mortality (P = .002). When the data were displayed graphically, there appeared to be an inflection point between 200 and 300 cases per year. When volume was analyzed as a categorical variable, the relationship was most apparent for difficult operations (Aristotle technical difficulty component score, >3.0), for which mortality decreased from 14.8% (60/406) at small programs to 8.4%(157/1858) at very large programs (P = .02). The same was true for the subgroup of patients who underwent Norwood procedures (36.5%[23/63] vs 16.9%[81/479], P < .0001). After risk adjustment, all groups performed similarly for low-difficulty operations. Conversely, for difficult procedures, small programs performed significantly worse. For Norwood procedures, very large programs outperformed all other groups.
Conclusion: There was an inverse association between pediatric cardiac surgical volume and mortality that became increasingly important as case complexity increased. Although volume was not associated with mortality for low-complexity cases, lower-volume programs underperformed larger programs as case complexity increased.
Metrics
Details
- Title
- The complex relationship between pediatric cardiac surgical case volumes and mortality rates in a national clinical database
- Creators
- Karl F. Welke - Oregon Health & Science UniversitySean M. O'Brien - Duke Clin Res Inst, Outcomes Res & Assessment Grp, Durham, NC USAEric D. Peterson - Duke Clin Res Inst, Outcomes Res & Assessment Grp, Durham, NC USARoss M. Ungerleider - Case Western Reserve UniversityMarshall L. Jacobs - Drexel UniversityJeffery P. Jacobs - Congenital Heart Inst Florida, St Petersburg, FL USA
- Publication Details
- The Journal of thoracic and cardiovascular surgery, v 137(5), pp 1133-1140
- Publisher
- Elsevier
- Number of pages
- 8
- Resource Type
- Journal article
- Language
- English
- Web of Science ID
- WOS:000265299000014
- Scopus ID
- 2-s2.0-64649092260
- Other Identifier
- 991021901513804721
UN Sustainable Development Goals (SDGs)
This publication has contributed to the advancement of the following goals:
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems
- Respiratory System
- Surgery