Care Models and Associated Outcomes in Congenital Heart Surgery

Burstein, Danielle S.; Jacobs, Jeffrey P.; Li, Jennifer S.; Sheng, Shubin; O’Brien, Sean M.; Rossi, Anthony F.; Checchia, Paul A.; Wernovsky, Gil; Welke, Karl F.; Peterson, Eric D.; Jacobs, Marshall L.; Pasquali, Sara K.

doi:10.1542/peds.2010-2796

Cited by 74 publications

(57 citation statements)

References 37 publications

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“…Further study is needed to develop and refine a failure to rescue measure in the pediatric cardiac surgery population, to analyze which postoperative complications should be included in such a measure, and to evaluate potential factors that may influence this measure, including differences in training and availability of personnel, and hospital structure, processes, and management practices. 25,26 …”

Section: Discussionmentioning

confidence: 99%

Association of Center Volume With Mortality and Complications in Pediatric Heart Surgery

et al. 2012

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WHAT'S KNOWN ON THIS SUBJECT: Previous analyses have suggested that center volume is associated with outcome in children undergoing heart surgery. There are limited data regarding factors that may mediate this volume-outcome relationship. WHAT THIS STUDY ADDS:A multicenter analysis of 35 776 children revealed that the higher mortality observed at lower volume centers may be related to a higher rate of mortality in those with postoperative complications, rather than a higher rate of complications alone. abstract OBJECTIVE: Previous analyses have suggested center volume is associated with outcome in children undergoing heart surgery. However, data are limited regarding potential mediating factors, including the relationship of center volume with postoperative complications and mortality in those who suffer a complication. We examined this association in a large multicenter cohort.METHODS: Children 0 to 18 years undergoing heart surgery at centers participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2006Database ( -2009 were included. In multivariable analysis, we evaluated outcomes associated with annual center volume, adjusting for patient factors and surgical risk category.RESULTS: A total of 35 776 patients (68 centers) were included. Overall, 40.6% of patients had $1 complication, and the in-hospital mortality rate was 3.9%. The mortality rate in those patients with a complication was 9.0%. In multivariable analysis, lower center volume was significantly associated with higher in-hospital mortality. There was no association of center volume with the rate of postoperative complications, but lower center volume was significantly associated with higher mortality in those with a complication (P = .03 when volume examined as a continuous variable; odds ratio in centers with ,150 vs .350 cases per year = 1.59 [95% confidence interval: 1.16-2.18]). This association was most prominent in the higher surgical risk categories.CONCLUSIONS: These data suggest that the higher mortality observed at lower volume centers in children undergoing heart surgery may be related to a higher rate of mortality in those with postoperative complications, rather than a higher rate of complications alone. Pediatrics 2012;129:e370-e376 AUTHORS:

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Section: Discussionmentioning

confidence: 99%

Association of Center Volume With Mortality and Complications in Pediatric Heart Surgery

et al. 2012

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“…Future studies should attempt to better characterize these apparently important, but as yet obscure, factors. One approach would be to assess the relative contributions to LOH of potentially modifiable factors previously reported in focused studies, such as presence of dedicated cardiac intensive care unit [22], use of fast-track protocols to extubation [23] or intensive care discharge [24], and specific approaches to central line care [25], sternal closure [26], and various aspects of blood transfusion management [27]. …”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Length of Postoperative Hospitalization for Pediatric Cardiac Operations in a Large North American Registry (1982–2007)

et al. 2016

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Introduction Surgical treatment of congenital heart disease represents a major cause of pediatric hospitalization and healthcare resource use. Larger centers may provide more efficient care with resulting shorter length of postoperative hospitalization (LOH). Materials and Methods Data from 46 centers over 25 years was used to evaluate whether surgical volume was an important determinant of LOH using a competing risk regression strategy that concurrently accounted for deaths, transfers, and discharges with some time interactions. Results Earlier discharge was more likely for infants and older children compared to neonates (subhazard ratios at post-operative day 6 of 1.64 [99% confidence interval (CI): 1.57, 1.72] and 2.67 [99% CI: 2.53, 2.80], respectively), but less likely for patients undergoing operations in Risk Adjustment for Congenital Heart Surgery categories 2, 3, 4, and 5&6 compared to category 1 (subhazard ratios at post-operative day 6 of 0.66 [99% CI: 0.64, 0.68], 0.34 [95% CI: 0.33, 0.35], 0.28 [99% CI:0.27, 0.30], and 0.10 [99% CI: 0.09, 0.11], respectively). There was no difference by sex (non-time dependent subhazard ratio 1.019 [99%CI: 0.995, 1.040]). For every 100-unit increase in center annual surgical volume, the non-time dependent subhazard for discharge was 1.035 (99%CI: 1.006, 1.064) times greater and center-specific exponentiated random effects ranged from 0.70 to 1.42 with a variance of 0.023. Discussion The conditional discharge rate increased with increasing age and later era. No sex-specific difference was found. Centers performing more operations discharged patients sooner than lower volume centers but this difference appears to be too small to be of clinical significance. Interestingly, unmeasured institutional characteristics estimated by the center random effects were variable suggesting that these played an important role in LOH and merit further investigation.

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“…However, our study demonstrated that the presence of a dedicated cardiac ICU was associated with lower mortality. In a recent study, Burstein and coworkers [13] did not detect a difference in postoperative morbidity or mortality associated with the presence of a dedicated cardiac ICU for children undergoing cardiac operations.…”

Section: Commentmentioning

confidence: 91%

Association of 24/7 In-House Intensive Care Unit Attending Physician Coverage With Outcomes in Children Undergoing Heart Operations

Gupta

Rettiganti

Jeffries

et al. 2016

The Annals of Thoracic Surgery

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Care Models and Associated Outcomes in Congenital Heart Surgery

Abstract: We were not able to detect a difference in postoperative morbidity or mortality associated with the presence of a dedicated CICU for children undergoing heart surgery. There may be a survival benefit in certain subgroups .

Cited by 74 publications

References 37 publications

Association of Center Volume With Mortality and Complications in Pediatric Heart Surgery

Association of Center Volume With Mortality and Complications in Pediatric Heart Surgery

Factors Affecting Length of Postoperative Hospitalization for Pediatric Cardiac Operations in a Large North American Registry (1982–2007)

Association of 24/7 In-House Intensive Care Unit Attending Physician Coverage With Outcomes in Children Undergoing Heart Operations

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