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High-volume medical centers do better job managing complications associated with pediatric heart surgery
Pasquali SK. Pediatrics. 2011;doi:10.1542/peds.2011-1188.
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Pediatric heart surgeries performed at lower-volume centers appear to be associated with a higher mortality in children with a postoperative complication, but not with a higher rate of postoperative complications alone, researchers reported in a recent study.
Of more than 35,000 pediatric heart surgery patients studied, 3.9% died in the hospital and 40.6% had at least one postoperative complication. In the group of children that suffered a complication, the overall mortality rate was 9%.
High- and low-volume centers had similar rates of postoperative complications. However, for children with a postoperative complication, lower-volume centers with fewer than 150 cases per year had a death rate that was 1.6 times higher than that at medical centers with more than 350 cases per year (OR=1.59; 95% CI, 1.16-2.18). “This association was most prominent in higher surgical risk categories,” researchers wrote in the study.
The multicenter analysis included pediatric heart surgery patients aged 0 to 18 years from the Society of Thoracic Surgeons Congenital Heart Surgery Database. Participants underwent surgery at 79 North American centers from 2006 to 2009. Nearly half (49%) of centers studied had fewer than 150 pediatric heart surgery cases per year, 31% had 150 to 250 cases per year, 13% had 250 to 350 cases per year and 7% had more than 350 cases per year. The researchers evaluated CV, infectious, neurologic, pulmonary, renal and surgical complications that occurred after surgery. Major postoperative complications examined included unplanned reoperation during admission, acute renal failure requiring dialysis, permanent neurologic deficit persisting at discharge and new-onset seizures, among others.
“Initiatives aimed at improving outcomes may need to focus on not only reducing complications but also improving recognition and management of complications once they occur,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
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