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Pediatric cardiac surgery mortality rate declines in UK
From 2000 to 2010, the number of pediatric cardiac surgery procedures performed in the United Kingdom increased, but rates of 30-day mortality have declined, according to data published in Open Heart.
Katherine L. Brown, PhD, MSc, from the Institute for Cardiovascular Science at University College London, and colleagues evaluated mandatory submissions to the National Institute of Cardiovascular Outcomes Research (NICOR) in the United Kingdom related to pediatric cardiac surgery from 2000 to 2010.
The primary outcome was 30-day mortality after cardiac surgery. Mortality risk was evaluated according to the partial risk adjustment in surgery (PRAiS) model, which groups patients into four bands based on estimated risk: less than 1% (band 1); 1% to 3% (band 2); 3% to 10% (band 3); and more than 10% (band 4).
The analysis included 36,641 cardiac surgeries performed in 30,041 patients. The number of surgical episodes was significantly increased during the study period, from 2,283 in 2000 to 3,939 in 2009 (P < .01). This increase was observed across all four bands estimated mortality risk using the PRAiS model, but was lowest among patients with less than 1% estimated risk (band 1).
The raw 30-day mortality rate declined from 4.3% to 2.6% from 2000 to 2010 (P < .01). Among patients with less than 1% estimated mortality risk, the 30-day mortality rate decreased significantly from 1.4% in 2000 to 0.5% in 2009-2010 (P < .01 for trend). Declines also were observed among patients with 1% to 3% estimated risk (change, 3.2% to 1.6%; P = .09) and 3% to 10% estimated risk (change, 11.1% to 4.5%). Researchers reported a nonsignificant increase in the 30-day mortality rate among patients with greater than 10% estimated risk (change, 10.3% to 12.7%).
Specific procedures also were linked to improved mortality at 30 days, including arterial switch with ventricular septal defect repair, patent ductus arteriosus ligation, Fontan-type operations and tetralogy of Fallot and ventricular septal defect repair, when surgeries performed from 2000 to 2004 were compared with those performed from 2005 to 2010. The 30-day mortality rate increased significantly only among patients with systemic to pulmonary arterial shunt during the later period.
The complexity of cases increased during the study period. More patients presented with functionally univentricular hearts (13.2% in 2000 vs. 16.3% in 2009-2010; P < .01), higher-risk diagnoses (6.7% vs. 9.5%; P < .01) and weight less than 2.5 kg (8.1% vs. 10.4%; P = .05) in later years.
“The very low mortality rates at 30 days must shift our focus now toward measures of morbidity, longer-term survival and functional outcomes, which, although of great importance to patients and their families, are less well delineated and, furthermore, may provide evidence on the comparative long-term benefits of different surgical strategies and models of care,” Brown and colleagues wrote. – by Adam Taliercio
Disclosure: The researchers report serving on the steering committee of the Congenital Heart Disease Audit within NICOR and receiving royalty payments associated with their development of software to implement the PRAiS model.