Effect of center volume on outcome of ventricular septal defect closure and arterial switch operation

This study evaluates the effects of surgical volume and preoperative patient characteristics on length of stay following ventricular septal defect (VSD) repair and arterial switch operation (ASO). Twenty-four centers contributed data on 16,795 consecutive surgical procedures from January 1, 1992 to December 31, 1996 to the Pediatric Cardiac Care Consortium Registry. The following variables were used in the analysis: center, center volume, age, weight, date of operation, preoperative hospital days, presence of trisomy 21, and significant coexisting heart defects (risk). For VSD, all variables were associated with length of stay in the univariate analyses; however, in the multivariate model, center volume did not retain significance. Length of stay for ASO was associated with center, center volume, and preoperative days in the univariate analysis. In the multivariate analysis for ASO, center and center volume were significant variables for predicting length of stay. These findings suggest that length of stay for uncomplicated surgical procedures is not related to surgical volume; however, for technically demanding procedures, length of stay tends to be shorter in centers with more experience.