Prioritizing quality improvement in pediatric cardiac surgery

Area of Science:

• Pediatric Cardiology
• Cardiac Surgery
• Quality Improvement

Background:

• Quality improvement initiatives are ongoing in pediatric cardiology and cardiac surgery.
• An objective prioritization scheme is needed for these initiatives, focusing on morbidity in low-mortality settings.

Purpose of the Study:

• To develop an objective prioritization scheme for quality improvement in pediatric cardiac surgery.
• To identify procedures with high morbidity burden based on encounter frequency and quality metrics.

Main Methods:

• Analyzed data from 67,550 pediatric cardiac surgery patients (Risk Adjustment for Congenital Heart Surgery 1 categories 1-6) from 2003-2011.
• Evaluated mortality, intensive care unit (ICU) and hospital length of stay (LOS), adverse events, and readmission rates.
• Developed a ranking and prioritization scheme based on these outcome measures.

Main Results:

• A small number of procedures contributed significantly to variations in hospital and ICU LOS.
• These procedures also accounted for most excess days of stay and readmission rates.
• Adverse event rates showed a linear relationship with Risk Adjustment for Congenital Heart Surgery 1 categories, with a few procedures disproportionately contributing.

Conclusions:

• A limited set of procedures drives a substantial portion of morbidity in pediatric cardiac surgery, even in low-mortality groups.
• Objective prioritization schemes are valuable for developing targeted quality improvement measures.