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Higher programmatic volume in paediatric heart surgery is associated with better early outcomes

Published online by Cambridge University Press:  16 December 2015

Andrzej Kansy ,
Tjark Ebels ,
Christian Schreiber ,
Jeffrey P. Jacobs ,
Zdzislaw Tobota  and
Bohdan Maruszewski
Andrzej Kansy*
Affiliation:
The Children’s Memorial Health Institute, Warsaw, Poland
Tjark Ebels
Affiliation:
University Medical Center Groningen, Groningen, the Netherlands
Christian Schreiber
Affiliation:
Department of Cardiovascular Surgery, German Heart Center Munich at the Technical University Munich, Munich, Germany
Jeffrey P. Jacobs
Affiliation:
Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins All Children’s Heart Institute, All Children’s Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, Orlando, Florida, United States of America Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Maryland, United States of America
Zdzislaw Tobota
Affiliation:
The Children’s Memorial Health Institute, Warsaw, Poland
Bohdan Maruszewski
Affiliation:
The Children’s Memorial Health Institute, Warsaw, Poland
*
Correspondence to: A. Kansy, The Children’s Memorial Health Institute, Department for Pediatric Cardiothoracic Surgery, Al. Dzieci Polskich 20, 04-830 Warsaw, Poland. Tel: +48228157346; Fax: +48228157340; E-mail: ankansy@wp.pl
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Abstract

Objective

Previous analyses have suggested an association between centre volume and in-hospital mortality, post-operative complications, and mortality in those patients who suffer from a complication. We sought to determine the nature of this association using a multicentre cohort.

Methods

All the patients, aged 18 years or younger, undergoing heart surgery at centres participating in the European Congenital Heart Surgeons Database (2003–2013) were included. Programmes were grouped as follows: small <150; medium 150–250; large 251–349; very large >350. Multivariable logistic regression was used to identify the differences between groups with the adjusted in-hospital mortality, onset of any and/or major complication, and in-hospital mortality in those patients with any and/or major complication. The outcomes were adjusted for patient specific risk factors and surgical risk factors.

Results

The data set consisted of 119,345 procedures performed in 99 centres. Overall, in-hospital mortality was 4.63%; complications occurred in 23.4% of the patients. In-hospital mortality in patients with complications was 13.82%. Multivariable logistic regression showed that the risk of in-hospital death was higher in low- and medium-volume centres (p<0.001). The rate of the occurrence of any post-operative complication in small, medium, and large programmes was lower compared with very large centres (p<0.001). Low- and medium-volume centres were associated with significantly higher mortality in patients with any complication (p<0.001).

Conclusions

Our analysis showed that the risk of in-hospital mortality was lower in higher-volume centres. Although the risk of complications is higher in high-volume centres, the mortality associated with complications that occurred in these centres was lower.

Keywords

Congenital heart diseasepaediatric heart diseasepatient safetyearly resultsoutcome
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 8: HeartWeek 2015 , December 2015 , pp. 1572 - 1578
Copyright
© Cambridge University Press 2015 

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