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Published on: July 18, 2014
Procedure-Specific Center Volume and Mortality After Infantile Congenital Heart Surgery
Rachel Zmora1, Logan Spector2, John Bass2
1Section of Preventive Medicine & Epidemiology, Boston University School of Medicine, Boston, Massachusetts.
Insights
Higher center volume in congenital heart surgery (CHS) is linked to lower early mortality for infants. However, center volume did not impact long-term survival rates after CHS.
Area of Science:
- Pediatric Cardiac Surgery
- Health Services Research
- Outcomes Research
Background:
- Regionalization of congenital heart surgery (CHS) aims to improve outcomes by concentrating care for high-risk pediatric patients.
- The impact of procedure-specific center volume on infant mortality after CHS requires further investigation.
Purpose of the Study:
- To determine if procedure-specific center volume is associated with mortality in infants undergoing CHS up to three years post-procedure.
- To analyze the relationship between surgical center experience and patient survival rates.
Main Methods:
- Analysis of data from 12,263 infants undergoing CHS between 1982 and 2003 at 46 US centers.
- Logistic regression was used to assess the association between center volume and mortality, adjusting for patient and surgical factors.
- Mortality was examined from discharge to 3 years post-procedure, with a sensitivity analysis excluding early deaths.
Main Results:
- Decreased odds of in-hospital mortality were observed for Norwood procedures, arterial switch operations, tetralogy of Fallot repairs, Glenn shunts, and VSD closures with increasing center volume.
- This inverse association between center volume and mortality persisted up to 3 years post-surgery for Norwood procedures, arterial switches, and VSD closures.
- Excluding deaths within 90 days of surgery eliminated the association between center volume and mortality for all procedures studied.
Conclusions:
- Procedure-specific center volume is inversely associated with early postoperative mortality in infantile CHS.
- Center volume does not appear to have a measurable effect on later mortality beyond the initial postoperative period.
Background:
Regionalization of congenital heart surgery (CHS) has been proposed to improve postsurgical outcomes by increasing experience in the care of high-risk patients. We sought to determine whether procedure-specific center volume was associated with mortality after infantile CHS up to 3 years post-procedure.
Methods:
We analyzed data from 12,263 infants in the Pediatric Cardiac Care Consortium undergoing CHS between 1982 and 2003 at 46 centers within the United States. We used logistic regression to assess the association between procedure-specific center volume and mortality from discharge to 3 years post-procedure, accounting for clustering at the center level and adjusting for patient age and weight at surgery, chromosomal abnormality, and surgical era.
Results:
We found decreased odds for in-hospital mortality for Norwood procedures (odds ratio [OR] 0.955, 95% CI 0.935-0.976), arterial switch operations (OR 0.924, 95% CI 0.889-0.961), tetralogy of Fallot repairs (OR 0.975, 95% CI 0.956-0.995), Glenn shunts (OR 0.971, 95% CI 0.943-1.000), and ventricular septal defect closures (OR 0.974, 95% CI 0.964-0.985). The association persisted up to 3 years post-surgery for Norwood procedures (OR 0.971, 95% CI 0.955-0.988), arterial switches (OR 0.929, 95% CI 0.890-0.970), and ventricular septal defect closures (OR 0.986, 95% CI 0.977-0.995); however, after excluding deaths that occurred within the first 90 days of following surgery, we observed no association between center volume and mortality for any of the procedures studied.
Conclusions:
These findings suggest that procedure-specific center volume is inversely associated with early postoperative mortality for infantile CHS across the complexity spectrum but has no measurable effect on later mortality.
