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Examining variation in interstage mortality rates across the National Pediatric Cardiology Quality Improvement Collaborative: do lower-mortality centres have lower-risk patients?

  • Katherine E. Bates (a1), Sunkyung Yu (a1), Ray Lowery (a1), Sara K. Pasquali (a1), David W. Brown (a2), Peter B. Manning (a3) and Karen Uzark (a1) (a4)...

Abstract

Background

Although interstage mortality for infants with hypoplastic left heart syndrome has declined within the National Pediatric Cardiology Quality Improvement Collaborative, variation across centres persists. It remains unclear whether centres with lower interstage mortality have lower-risk patients or whether differences in care may explain this variation. We examined previously established risk factors across National Pediatric Cardiology Quality Improvement Collaborative centres with lower and higher interstage mortality rates.

Methods

Lower-mortality centres were defined as those with >25 consecutive interstage survivors. Higher-mortality centres were defined as those with cumulative interstage mortality rates >10%, which is a collaborative historic baseline rate. Baseline risk factors and perioperative characteristics were compared.

Results

Seven lower-mortality centres were identified (n=331 patients) and had an interstage mortality rate of 2.7%, as compared with 13.3% in the four higher-mortality centres (n=173 patients, p<0.0001). Of all baseline risk factors examined, the only factor that differed between the lower- and higher-mortality centres was postnatal diagnosis (18.4 versus 31.8%, p=0.001). In multivariable analysis, there remained a significant mortality difference between the two groups of centres after adjusting for this variable: adjusted mortality rate was 2.8% in lower-mortality centres compared with 12.6% in higher-mortality centres, p=0.003. Secondary analyses identified multiple differences between groups in perioperative practices and other variables.

Conclusions

Variation in interstage mortality rates between these two groups of centres does not appear to be explained by differences in baseline risk factors. Further study is necessary to evaluate variation in care practices to identify targets for improvement efforts.

Copyright

Corresponding author

Author for correspondence: K. E. Bates, MD MS, Congenital Heart Center, C.S. Mott Children’s Hospital, University of Michigan Medical School, 1540 E. Hospital Drive, Ann Arbor, MI 48109 4204, USA. Tel: 734 232 8426; Fax: 734 936 4628; E-mail: kebates@med.umich.edu

Footnotes

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Cite this article: Bates KE, Yu S, Lowery R, Pasquali SK, Brown DW, Manning PB, Uzark K. (2018) Examining variation in interstage mortality rates across the National Pediatric Cardiology Quality Improvement Collaborative: do lower-mortality centres have lower-risk patients? Cardiology in the Young 28: 1031–1036. doi: 10.1017/S1047951118000926

Footnotes

References

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