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Mortality rate is not a valid indicator of quality differences between pediatric cardiac surgical programs
Karl F Welke1, Tara Karamlou, Ross M Ungerleider
1Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon 97239-3098, USA. welkek@ohsu.edu
The Annals of Thoracic Surgery
|January 28, 2010
Summary
Pediatric cardiac surgery volumes and mortality rates are too low for reliable hospital comparisons. Most hospitals lack sufficient cases to detect meaningful differences in mortality outcomes.
Area of Science:
- Pediatric cardiac surgery outcomes research
- Healthcare quality assessment
- Statistical analysis in medicine
Background:
- Accurate assessment of hospital quality requires sufficient sample sizes and event rates.
- The hypothesis posits that pediatric cardiac surgery case volumes and mortality rates are too low for effective hospital differentiation based on mortality.
Purpose of the Study:
- To evaluate if pediatric cardiac surgery case volumes and mortality rates are adequate for valid hospital quality comparisons.
- To determine the sample size and event rate thresholds needed for statistically significant mortality difference detection.
Main Methods:
- Analysis of U.S. pediatric cardiac surgical operations (21,709 from 161 hospitals) in the Nationwide Inpatient Sample (NIS) Database (2000-2005).
- Calculation of hospital annual surgical volumes and in-hospital mortality rates for Risk Adjustment for Congenital Heart Surgery (RACHS-1) categories and individual operations.
- Comparison of actual case volumes with thresholds required to detect a doubling or a 5-percentage point increase in mortality.
Main Results:
- No hospital possessed sufficient annual case volume to detect a doubling or 5-percentage point mortality increase for individual operations.
- A small percentage (0%–5.6%) of hospitals had adequate volume for specific RACHS-1 categories.
- Minimum case volumes to detect mortality differences ranged from 11 to 2,935 for RACHS-1 categories and 525 for overall hospital mortality.
Conclusions:
- Pediatric cardiac surgery operations are performed too infrequently to allow valid hospital quality comparisons based on mortality.
- Mortality rates in pediatric cardiac surgery are generally too low to serve as a reliable metric for inter-hospital quality assessment.
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