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Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
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Reevaluating Congenital Heart Surgery Center Performance Using Operative Mortality.

Sharon-Lise T Normand1, Katya Zelevinsky2, Meena Nathan3

  • 1Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts; Department of Biostatistics, Harvard Chan School of Public Health, Boston, Massachusetts.

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|February 5, 2022
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Summary
This summary is machine-generated.

New methods for analyzing congenital heart surgery outcomes show improved performance categorization for many centers. These advanced approaches offer more precise quality reports for congenital heart centers.

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Area of Science:

  • Cardiovascular Surgery
  • Health Services Research
  • Biostatistics

Background:

  • The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) provides observed-to-expected (O/E) operative mortality ratios to North American congenital heart centers.
  • Current methods for estimating O/E ratios may not fully capture center performance variations.

Purpose of the Study:

  • To compare the current STS-CHSD approach for estimating O/E ratios with novel methods.
  • To evaluate approaches that incorporate diagnosis-procedure interactions, additional risk factors, and refined confidence interval construction for characterizing center performance.

Main Methods:

  • Bayesian additive regression trees (BART) and lasso models were used to link operative mortality to diagnosis-procedure categories, procedure-specific risk factors, and syndromes/abnormalities.
  • Bootstrapping was employed to account for variation in the STS-CHSD (STS bootstrap) and lasso confidence intervals (CIs).
  • O/E estimates, CI widths, and concordance of center performance categorizations were compared across methods.

Main Results:

  • In an analysis of 110 centers and 98,822 operations, BART and lasso models yielded O/E ratios with greater variability and narrower CIs compared to the STS-CHSD.
  • Concordance of performance categorization ranged from 84% (lasso) to 91% (STS Bootstrap), with over 70% of discordant centers showing improved categories.
  • Discordant centers were characterized by smaller surgical volumes, fewer mortalities, and a higher proportion of patients with congenital lung abnormalities.

Conclusions:

  • New analytical approaches can lead to significant shifts in hospital performance categories, with most centers improving their standing.
  • Incorporating additional risk factors and addressing unaddressed variation is crucial for accurate quality reporting in congenital heart surgery.
  • These findings highlight the importance of refining risk adjustment models for evaluating and comparing congenital heart center performance.