Higher programmatic volume in paediatric heart surgery is associated with better early outcomes
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Andrzej Kansy1, Tjark Ebels2, Christian Schreiber3
11The Children's Memorial Health Institute,Warsaw,Poland.
Insights
Higher volume heart surgery centers are linked to lower in-hospital mortality. While high-volume centers may see more complications, patient survival after complications is better.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Health Services Research
Background:
- Previous studies suggest a link between hospital procedure volume and patient outcomes.
- Understanding this association is crucial for optimizing care in congenital heart surgery.
Purpose of the Study:
- To investigate the relationship between center volume and in-hospital mortality, post-operative complications, and mortality after complications in pediatric heart surgery.
- To determine if center volume influences the outcomes of congenital heart surgery.
Main Methods:
- Analysis of the European Congenital Heart Surgeons Database (2003-2013).
- Inclusion of 119,345 pediatric heart surgeries from 99 centers, categorized by volume (small, medium, large, very large).
- Multivariable logistic regression adjusted for patient and surgical risk factors to assess mortality and complication rates.
Main Results:
- In-hospital mortality was 4.63%, with complications in 23.4% of patients.
- Low- and medium-volume centers had higher in-hospital mortality.
- High-volume centers had a lower rate of complications but higher mortality in patients who experienced complications.
Conclusions:
- Higher-volume congenital heart surgery centers are associated with reduced in-hospital mortality.
- Although high-volume centers may have a higher incidence of complications, the mortality related to these complications is lower.
Objective:
Previous analyses have suggested an association between centre volume and in-hospital mortality, post-operative complications, and mortality in those patients who suffer from a complication. We sought to determine the nature of this association using a multicentre cohort.
Methods:
All the patients, aged 18 years or younger, undergoing heart surgery at centres participating in the European Congenital Heart Surgeons Database (2003-2013) were included. Programmes were grouped as follows: small 350. Multivariable logistic regression was used to identify the differences between groups with the adjusted in-hospital mortality, onset of any and/or major complication, and in-hospital mortality in those patients with any and/or major complication. The outcomes were adjusted for patient specific risk factors and surgical risk factors.
Results:
The data set consisted of 119,345 procedures performed in 99 centres. Overall, in-hospital mortality was 4.63%; complications occurred in 23.4% of the patients. In-hospital mortality in patients with complications was 13.82%. Multivariable logistic regression showed that the risk of in-hospital death was higher in low- and medium-volume centres (p<0.001). The rate of the occurrence of any post-operative complication in small, medium, and large programmes was lower compared with very large centres (p<0.001). Low- and medium-volume centres were associated with significantly higher mortality in patients with any complication (p<0.001).
Conclusions:
Our analysis showed that the risk of in-hospital mortality was lower in higher-volume centres. Although the risk of complications is higher in high-volume centres, the mortality associated with complications that occurred in these centres was lower.
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