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Association of center volume with mortality and complications in pediatric heart surgery.

Publication ,  Journal Article
Pasquali, SK; Li, JS; Burstein, DS; Sheng, S; O'Brien, SM; Jacobs, ML; Jaquiss, RDB; Peterson, ED; Gaynor, JW; Jacobs, JP
Published in: Pediatrics
February 2012

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 = .03 when volume examined as a continuous variable; odds ratio in centers with <150 vs >350 cases 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.

Duke Scholars

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Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

February 2012

Volume

129

Issue

2

Start / End Page

e370 / e376

Location

United States

Related Subject Headings

  • United States
  • Statistics as Topic
  • Risk
  • Postoperative Complications
  • Pediatrics
  • Odds Ratio
  • Male
  • Infant
  • Humans
  • Hospital Mortality
 

Citation

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Pasquali, S. K., Li, J. S., Burstein, D. S., Sheng, S., O’Brien, S. M., Jacobs, M. L., … Jacobs, J. P. (2012). Association of center volume with mortality and complications in pediatric heart surgery. Pediatrics, 129(2), e370–e376. https://doi.org/10.1542/peds.2011-1188
Pasquali, Sara K., Jennifer S. Li, Danielle S. Burstein, Shubin Sheng, Sean M. O’Brien, Marshall L. Jacobs, Robert D. B. Jaquiss, Eric D. Peterson, J William Gaynor, and Jeffrey P. Jacobs. “Association of center volume with mortality and complications in pediatric heart surgery.Pediatrics 129, no. 2 (February 2012): e370–76. https://doi.org/10.1542/peds.2011-1188.
Pasquali SK, Li JS, Burstein DS, Sheng S, O’Brien SM, Jacobs ML, et al. Association of center volume with mortality and complications in pediatric heart surgery. Pediatrics. 2012 Feb;129(2):e370–6.
Pasquali, Sara K., et al. “Association of center volume with mortality and complications in pediatric heart surgery.Pediatrics, vol. 129, no. 2, Feb. 2012, pp. e370–76. Pubmed, doi:10.1542/peds.2011-1188.
Pasquali SK, Li JS, Burstein DS, Sheng S, O’Brien SM, Jacobs ML, Jaquiss RDB, Peterson ED, Gaynor JW, Jacobs JP. Association of center volume with mortality and complications in pediatric heart surgery. Pediatrics. 2012 Feb;129(2):e370–e376.

Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

February 2012

Volume

129

Issue

2

Start / End Page

e370 / e376

Location

United States

Related Subject Headings

  • United States
  • Statistics as Topic
  • Risk
  • Postoperative Complications
  • Pediatrics
  • Odds Ratio
  • Male
  • Infant
  • Humans
  • Hospital Mortality