Pediatric Cardiac Surgical Patterns of Practice and Outcomes in Japan and Europe

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Health Services Research

Background:

• The Japan Cardiovascular Surgery Database-Congenital section (JCVSD-Congenital) and the European Congenital Heart Surgeons Association (ECHSA) Congenital Heart Surgery Database (CHSD) utilize identical nomenclature.
• Comparative analysis of congenital cardiac surgical practices between distinct geographical regions is crucial for identifying best practices and potential improvements.

Purpose of the Study:

• To compare congenital cardiac surgical patterns of practice and patient outcomes between Japan and Europe.
• To leverage data from the JCVSD-Congenital and ECHSA-CHSD for a comprehensive cross-continental comparison.

Main Methods:

• Analysis of data from the JCVSD-Congenital and ECHSA-CHSD covering 2011-2017.
• Inclusion of 120 Japanese units (63,365 operations) and 96 European units (90,098 operations).
• Calculation of patient demographics, procedural data, mortality at hospital discharge, and postoperative length of stay for ten benchmark operations.

Main Results:

• Significant differences observed in the proportion of specific benchmark operations performed, with higher rates of ventricular septal defect closures and Glenn operations in Japan, and lower rates for several other complex procedures compared to Europe.
• Postoperative length of stay was consistently longer in Japan across all benchmark operations.
• Mean STAT mortality score was higher in Japan (0.78) versus Europe (0.71), yet hospital discharge mortality was significantly lower in Japan (4.2%) compared to Europe (6.0%).

Conclusions:

• Congenital cardiac surgery practices, including procedure distribution and patient age at surgery, differ significantly between Japan and Europe.
• Japanese patients experienced longer postoperative stays and higher mean complexity, despite lower in-hospital mortality rates.
• These findings underscore opportunities for bidirectional collaboration to enhance quality improvement in congenital heart surgery globally.