Adverse event rates in congenital cardiac catheterization - a multi-center experience
Lisa Bergersen1, Audrey Marshall, Kimberlee Gauvreau
1Children's Hospital Boston, Boston, MA, USA. Lisa.Bergersen@cardio.chboston.org
Insights
Adverse event rates in congenital cardiac catheterization are higher for interventional cases than diagnostic ones, and very low for biopsy cases. Risk adjustment is needed for fair institutional comparisons.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Adverse event rates in congenital cardiac catheterization vary due to differing data standards and case mix.
- Standardized reporting is crucial for accurate comparison of patient outcomes.
Purpose of the Study:
- To analyze case mix variation across institutions performing congenital cardiac catheterization.
- To report adverse event rates stratified by procedure type.
Main Methods:
- Data from 3855 cardiac catheterizations at six pediatric institutions were collected.
- Case characteristics and adverse events were captured and audited for validity.
- Proportions of general anesthesia, emergent procedures, and intervention types were analyzed.
Main Results:
- Interventional cases had significantly higher adverse event rates (20%) compared to diagnostic cases (10%).
- Higher severity adverse events were also more common in interventional procedures (9% vs 5%).
- Biopsy cases demonstrated a low incidence of adverse events.
Conclusions:
- Adverse event incidence in congenital cardiac catheterization differs significantly by procedure type.
- Interventional procedures carry a higher risk of adverse events than diagnostic procedures.
- Development of risk adjustment methods is essential for equitable institutional comparisons.
Objectives:
To describe case mix variation among institutions, and report adverse event rates in congenital cardiac catheterization by case type.
Background:
Reported adverse event rates for patients with congenital heart disease undergoing cardiac catheterization vary considerably, due to non-comparable standards of data inclusion, and highly variable case mix.
Methods:
The Congenital Cardiac Catheterization Outcomes Project (C3PO) has been capturing case characteristics and adverse events (AE) for all cardiac catheterizations performed at six pediatric institutions. Validity and completeness of data were independently audited.
Results:
Between 2/1/07 and 4/30/08, 3855 cases (670 biopsy, 1037 diagnostic, and 2148 interventional) were recorded, median number of cases per site 480 (308 to 1526). General anesthesia was used in 70% of cases (28 to 99%), and 22% of cases (15 to 26%) were non-electively or emergently performed. Three institutions performed a higher proportion of interventions during a case, 72 to 77% compared to 56 to 58%. The median rate of AE reported per institution was 16%, ranging from 5 to 18%. For interventional cases the median rate of AE reported per institution was 19% (7 to 25%) compared to 10% for diagnostic cases (6 to 16%). The incidence of AE was significantly higher for interventional compared to diagnostic cases (20% vs 10%, p<0.001), as was the incidence of higher severity AE (9% vs 5%, p<0.001). Adverse events in biopsy cases were uncommon.
Conclusions:
In this multi-institutional cohort, the incidence of AE is higher among interventional compared to diagnostic cases, and is very low among biopsy cases. Equitable comparisons among institutions will require the development and application of risk adjustment methods.
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