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OBJECTIVE: To examine the impact of hospital caseload on in-hospital mortality for pediatric congenital heart surgery. DESIGN: Population-based, retrospective cohort study. SETTING: Acute care hospitals in California and Massachusetts. PATIENTS: Children undergoing surgery for congenital heart disease, identified by the presence of procedure codes indicating surgical repair of a congenital heart defect in computerized statewide hospital discharge abstract databases. Cases were grouped into four categories based on the complexity of the procedure. MAIN OUTCOME MEASURES: Adjusted odds ratios (OR) for in-hospital death were estimated using generalized estimating equations that account for the intra-institutional correlation among patients. RESULTS: A total of 2833 cases at 37 centers were identified. Compared with centers performing > 300 cases per year, after controlling for patient characteristics, centers performing 300 cases annually. This study was limited by the absence of clinical detail in discharge abstract databases. If these findings are corroborated by other studies, health care delivery strategies that direct children requiring surgical correction of congenital heart defects to high-volume centers may substantially reduce overall mortality.
Jenkins et al. (Wed,) studied this question.