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Published on: July 18, 2014
Hospital Volume and Noncardiac Surgery Outcomes for Patients With Congenital Heart Disease
Michael T Kuntz1, Steven J Staffa2, Jay G Berry3
1Division of Pediatric Cardiac Anesthesia, Department of Anesthesiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN.
Insights
Patients with congenital heart disease (CHD) undergoing noncardiac surgery face higher mortality, especially at mid-volume hospitals. This study highlights that hospital volume significantly impacts surgical outcomes for this vulnerable population.
Area of Science:
- Cardiology
- Surgical Outcomes
- Public Health
Background:
- Patients with congenital heart disease (CHD) experience higher mortality rates during noncardiac surgery compared to those without CHD.
- Understanding factors influencing surgical outcomes in CHD patients is crucial for improving care.
- Institutional volume is a potential determinant of patient outcomes.
Purpose of the Study:
- To investigate the impact of hospital volume on mortality and length of stay for patients with congenital heart disease (CHD) undergoing noncardiac surgery.
- To identify specific hospital volume quintiles associated with adverse outcomes in this patient population.
Main Methods:
- Retrospective analysis of inpatient data from the Pediatric Health Information System (2016-2023).
- Patients undergoing noncardiac surgery were categorized by congenital heart disease (CHD) status (none, simple, complex, single ventricle).
- Hospitals were stratified into quintiles based on the volume of noncardiac procedures performed on CHD patients.
Main Results:
- Mortality was highest in mid-volume centers (quintile 3) for the overall cohort, non-CHD patients, and complex CHD patients.
- Multivariable analysis confirmed that mid-volume centers (quintile 3) were associated with increased in-hospital mortality (aOR 1.14, p=0.034).
- Length of stay showed variable patterns across different CHD types and hospital volumes.
Conclusions:
- Mid-volume hospitals are associated with higher in-hospital mortality for patients with congenital heart disease undergoing noncardiac surgery.
- Length of stay patterns are inconsistent across hospital volumes and CHD types.
- Further research is needed to understand the reasons for these volume-based outcome disparities and to explore the potential benefits of care regionalization.
Objectives:
Mortality when undergoing noncardiac surgery for patients with congenital heart disease (CHD) remains higher than for patients without CHD. We sought to determine the impact of institutional volume on outcomes for noncardiac surgery for patients with CHD.
Design:
Retrospective database study.
Participants:
Inpatients undergoing noncardiac procedures identified using the Pediatric Health Information System (2016-2023) were included in the assessment. Data were organized by hospital volume quintile, based on the number of patients with CHD undergoing noncardiac procedures.
Measurements And Main Results:
Of 662,680 patients undergoing noncardiac surgery, 617,396 had no CHD, 23,712 had simple heart disease, 16,243 had complex heart disease, and 5,329 had single-ventricle disease. Quintile 1 hospitals performed fewer than 500 noncardiac procedures for patients with CHD over the study period, quintile 3 hospitals performed 900 to less than 1,100, and quintile 5 hospitals performed more than 1,500. Demographics were similar across volume quintiles. Mortality was highest in quintile 3 among the full cohort (0.83%, p < 0.001), the non-CHD cohort (0.56%, p = 0.009), and the complex CHD cohort (6.28%, p = 0.024). For simple and single-ventricle lesions, in-hospital mortality rates were similar across quintiles. The longest length of stay varied, including quintile 3 (simple), quintile 1 (complex), and quintiles 2 and 3 (single ventricle). In multivariable analysis, volume quintile 3 was associated with higher in-hospital mortality (adjusted odds ratio 1.14, 95% confidence interval 1.01-1.3, p = 0.034).
Conclusions:
In-hospital mortality is higher for patients with CHD undergoing noncardiac surgery at mid-volume centers; length of stay demonstrates a more variable pattern. The reasons for such differences and the implications for regionalization of care require further study.
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