Key result
While overall unadjusted in-hospital mortality did not differ significantly between cardiac surgeries performed in Croatia (5%) and abroad (4%), mortality and complication rates were significantly higher in Croatia for moderately complex procedures after risk adjustment.
Why the study?
Does the location of congenital cardiac surgery (Croatia vs abroad) affect in-hospital mortality and complications after adjusting for surgical complexity?
Observational (n=556)
Yes
Does the location of congenital cardiac surgery (Croatia vs abroad) affect in-hospital mortality and complications after adjusting for surgical complexity?
After adjusting for surgical complexity, congenital heart surgery performed in Croatia had higher mortality and complication rates in certain risk categories compared to procedures performed abroad, highlighting the need for program retraining and centralization.
Higher adjusted risks for moderate-complexity cases in Croatia warrant caution; leaves open the impact of volume and expertise on congenital surgery outcomes.
OBJECTIVE: The Aristotle basic complexity score and the risk adjustment in congenital cardiac surgery-1 method were developed and used to compare outcomes of congenital cardiac surgery. Both methods were used to compare results of procedures performed on our patients in Croatian cardiosurgical centres and results of procedures were taken abroad. METHODS: The study population consisted of all patients with congenital cardiac disease born to Croatian residents between 1 October, 2002 and 1 October, 2007 undergoing a cardiovascular operation during this period. RESULTS: Of the 556 operations, the Aristotle basic complexity score could be assigned to 553 operations and the risk adjustment in congenital cardiac surgery-1 method to 536 operations. Procedures were performed in two institutions in Croatia and seven institutions abroad. The average complexity for cardiac procedures performed in Croatia was significantly lower. With both systems, along with the increase in complexity, there is also an increase in mortality before discharge and postoperative length of stay. Only after the adjustment for complexity there are marked differences in mortality and occurrence of postoperative complications. CONCLUSION: Both, the Aristotle basic complexity score and the risk adjustment in congenital cardiac surgery-1 method were predictive of in-hospital mortality as well as prolonged postoperative length to stay, and can be used as a tool in our country to evaluate a cardiosurgical model and recognise potential problems.
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Dilber et al. (2010) conducted an observational in Congenital heart disease (n=556). Cardiac surgery in Croatia vs. Cardiac surgery abroad was evaluated on In-hospital mortality (p=0.667). While overall unadjusted in-hospital mortality did not differ significantly between cardiac surgeries performed in Croatia (5%) and abroad (4%), mortality and complication rates were significantly higher in Croatia for moderately complex procedures after risk adjustment.
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