Key result
Lower center volume (<150 vs >350 cases/year) was significantly associated with higher mortality in children with postoperative complications (OR 1.59; 95% CI 1.16-2.18; P=0.03).
Why the study?
Does lower center volume increase mortality and complications in children undergoing heart surgery?
Cohort (n=35,776)
Yes
Does lower center volume increase mortality and complications in children undergoing heart surgery?
Odds Ratio: 1.59 (95% CI 1.16–2.18)
p-value: p=0.03
Higher mortality at lower volume centers in pediatric heart surgery is driven by higher mortality among patients who suffer postoperative complications (failure to rescue), rather than a higher rate of complications.
Low-volume centers may have higher failure-to-rescue rates after pediatric cardiac surgery; supports targeted quality research but should not yet alter referrals.
SUBJECT: Previous analyses have suggested that center volume is associated with outcome in children undergoing heart surgery.There are limited data regarding factors that may mediate this volume-outcome relationship. WHAT THIS STUDY ADDS:A multicenter analysis of 35 776 children revealed that the higher mortality observed at lower volume centers may be related to a higher rate of mortality in those with postoperative complications, rather than a higher rate of complications alone.abstract OBJECTIVE: Previous analyses have suggested center volume is associated with outcome in children undergoing heart surgery.However, data are limited regarding potential mediating factors, including the relationship of center volume with postoperative complications and mortality in those who suffer a complication.We examined this association in a large multicenter cohort.METHODS: Children 0 to 18 years undergoing heart surgery at centers participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2006-2009) were included.In multivariable analysis, we evaluated outcomes associated with annual center volume, adjusting for patient factors and surgical risk category.RESULTS: A total of 35 776 patients (68 centers) were included.Overall, 40.6% of patients had $1 complication, and the in-hospital mortality rate was 3.9%.The mortality rate in those patients with a complication was 9.0%.In multivariable analysis, lower center volume was significantly associated with higher in-hospital mortality.There was no association of center volume with the rate of postoperative complications, but lower center volume was significantly associated with higher mortality in those with a complication (P = .03when volume examined as a continuous variable; odds ratio in centers with ,150 vs .350cases per year = 1.59 [95% confidence interval: 1.16-2.18]).This association was most prominent in the higher surgical risk categories.CONCLUSIONS: These data suggest that the higher mortality observed at lower volume centers in children undergoing heart surgery may be related to a higher rate of mortality in those with postoperative complications, rather than a higher rate of complications alone.
No takes yet. Share an insight, caveat, or question.
A 2012 study conducted a cohort in Pediatric heart surgery (n=35,776). Lower center volume (<150 cases per year) vs. Higher center volume (>350 cases per year) was evaluated on In-hospital mortality in patients with a postoperative complication (OR 1.59, 95% CI 1.16-2.18, p=0.03). Lower center volume (<150 vs >350 cases/year) was significantly associated with higher mortality in children with postoperative complications (OR 1.59; 95% CI 1.16-2.18; P=0.03).
Synapse has enriched 3 closely related papers on similar clinical questions. Consider them for comparative context: