Center Volume and Failure to Rescue in Pediatric Cardiac Surgery: Is There a Relationship?

Area of Science:

• Pediatric Cardiac Surgery
• Quality Metrics
• Healthcare Outcomes Research

Background:

• Failure to rescue (FTR) is a key quality metric in pediatric cardiac surgery.
• Assessing the link between hospital volume and FTR is crucial for outcome evaluation.

Purpose of the Study:

• To investigate the relationship between annual hospital case volume and failure to rescue (FTR) after pediatric cardiac surgery.
• To determine if hospital volume is a reliable predictor of patient outcomes in this surgical population.

Main Methods:

• Utilized the Kids' Inpatient Database (2016, 2019) for cardiopulmonary bypass (CPB) cases.
• Defined FTR as inpatient mortality following at least one postoperative complication.
• Categorized hospitals into low, mid, and high volume based on annual CPB case volume terciles.
• Employed a mixed-effects multivariable logistic model to analyze the association between case volume and FTR.

Main Results:

• Analyzed 10,528 patients with postoperative complications across 228 hospitals.
• No statistically significant difference in FTR rates was found between low, mid, and high-volume hospitals.
• Underperforming and overperforming hospitals were identified across all volume categories.

Conclusions:

• Hospital volume is not associated with failure to rescue (FTR) after pediatric cardiac surgery.
• The presence of underperformers and overperformers in all volume groups indicates variability independent of case volume.
• Hospital volume may not be a dependable metric for comparing quality and outcomes in pediatric cardiac surgery.