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Congenital Heart Surgery Program Variable Case Mix: Risk Associated With Adjusted Mortality Rate

Garick D Hill1, James Tweddell2, Andrew Redington1

  • 1The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.

The Annals of Thoracic Surgery
|August 20, 2022
PubMed

Insights

Congenital heart surgery programs show significant variation in risk stratification, with a higher proportion of lower-risk STAT 1 cases correlating with lower adjusted mortality rates. This suggests differences in surgical decision-making philosophies impact outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Health Services Research
  • Medical Informatics

Background:

  • Congenital heart operations are risk-stratified using The Society of Thoracic Surgeons-European Association of Cardio-Thoracic Surgery Congenital Heart Surgery (STAT) Mortality Categories.
  • Adjusted mortality rates aim to account for variations in patient case mix.

Purpose of the Study:

  • To evaluate the variability in STAT 1 (lowest risk) cases as a percentage of total operations and as a ratio to STAT 4+5 (highest risk) operations across congenital heart surgery programs.
  • To assess the relationship between this variability and adjusted mortality rates.

Main Methods:

  • Data from The Society of Thoracic Surgeons Congenital Heart Surgery Public Reporting were analyzed for the top 50 U.S. News & World Report Cardiology and Heart Surgery Programs (2015-2018).
  • Variability in STAT 1 cases (percentage of total and ratio to STAT 4+5) was assessed.
  • The association between the STAT 1:STAT 4+5 ratio and adjusted mortality was examined.

Main Results:

  • A significant 4-fold difference in the STAT 1 to STAT 4+5 ratio was observed among programs.
  • Programs with the highest STAT 1:STAT 4+5 ratio demonstrated a significantly lower median adjusted mortality rate (2.2% vs. 2.95%, P = .03).
  • An inverse relationship between the STAT 1:STAT 4+5 ratio and adjusted mortality did not reach statistical significance (P = .12).

Conclusions:

  • Substantial variation in the proportion of STAT 1 cases suggests differing clinical decision-making philosophies among congenital heart surgery programs.
  • While the STAT mortality risk model adjusts for case mix, it does not fully account for all inter-program variability.
  • The findings highlight potential areas for quality improvement and standardized risk assessment in congenital heart surgery.
Abstract

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