Improving and standardizing capture of pediatric cardiac surgical complications

Our objective was to establish baseline data and develop a tool to allow for systematic evaluation of pediatric cardiac surgical complications. As a first step, we examined the incidence and distribution of complications, risk stratified by case complexity in a single institution. With improving mortality rates for congenital heart surgery, the next frontier for improving patient outcomes is characterizing and reducing complications. Currently, no standardized approach is available to monitor the incidence and severity of all complications associated with a congenital cardiac surgery program.

Complications occurring in pediatric cardiac surgical patients (January 2006 to March 2009) were collected by database review applying standardized definitions. The surgical procedures were stratified by complexity to analyze the distribution of complications over the risk spectrum. Each complication was assigned a severity coefficient (1-3) used to calculate the combined effect of frequency and severity. The cumulative sum method was used to determined the trend of the adverse outcomes.

Of 292 procedures, 84 (28.8%) were associated with a total of 150 complications. Of the 150 complications, 37 occurred in patients who died. The most common complications were arrhythmias (14.5%), cardiac (12.6%), and operative (12.6%). There was a linear relationship between the frequency and severity of complications and surgical complexity, as stratified using the Risk Adjustment for Congenital Heart Surgery category or Aristotle basic complexity levels (Spearman's coefficient = 1).

When examined in a systematic fashion, the risk of complications in pediatric cardiac surgical patients is considerable. Our data illustrate that it is possible to track complications over time in a consistent manner. The effect of complication monitoring on patient outcomes remains to be proved.