Improvement in Pediatric Cardiac Surgical Outcomes Through Interhospital Collaboration

Background: Patients undergoing complex pediatric cardiac surgery remain at considerable risk of mortality and morbidity, and variation in outcomes exists across hospitals. We formed the Pediatric Cardiac Critical Care Consortium (PC4) to improve the quality of care for these patients through transparent data sharing and collaborative learning between participants. Objective: To determine whether outcomes improved over time within PC4. Methods: We analyzed 19,600 hospitalizations (18 hospitals) in the PC4 clinical registry that included cardiovascular surgery from 8/2014-6/2018. The primary exposure was two years of PC4 participation; this provided adequate time for hospitals to accrue data and engage in collaborative learning. Aggregate case mix-adjusted outcomes were compared between the first two years of participation (baseline) and all months post-exposure. We also evaluated outcomes from the same era in a cohort of similar, non-PC4 hospitals. Results: During the baseline period there was no evidence of improvement. We observed significant improvement in the post-exposure period vs. baseline for postoperative ICU mortality [2.1% vs. 2.7%; 22% relative reduction (RR), p=0.001], in-hospital mortality (2.5% vs. 3.3%; 24% RR, p=0.001), major complications (10.1% vs. 11.5%; 12% RR, p<0.001), ICU length of stay (7.3 days vs. 7.7; 5% RR, p<0.001), and duration of ventilation (61.3 hours vs. 70.6; 13% RR, p=0.01). Non-PC4 hospitals showed no significant improvement in mortality, complications, or hospital length of stay. Conclusions Our analysis demonstrates improving cardiac surgical outcomes at children’s hospitals participating in PC4. This change appears unrelated to secular improvement trends, and likely reflects PC4’s commitment to transparency and collaboration.