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Variation in outcomes for benchmark operations: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database.

Publication ,  Journal Article
Jacobs, JP; O'Brien, SM; Pasquali, SK; Jacobs, ML; Lacour-Gayet, FG; Tchervenkov, CI; Austin, EH; Pizarro, C; Pourmoghadam, KK; Scholl, FG ...
Published in: Ann Thorac Surg
December 2011

BACKGROUND: We evaluated outcomes for common operations in The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSDB) to provide contemporary benchmarks and examine variation between centers. METHODS: Patients undergoing surgery from 2005 to 2009 were included. Centers with greater than 10% missing data were excluded. Discharge mortality and postoperative length of stay (PLOS) among patients discharged alive were calculated for 8 benchmark operations of varying complexity. Power for analyzing between-center variation in outcome was determined for each operation. Variation was evaluated using funnel plots and Bayesian hierarchical modeling. RESULTS: Eighteen thousand three hundred seventy-five index operations at 74 centers were included in the analysis of 8 benchmark operations. Overall discharge mortality was: ventricular septal defect (VSD) repair = 0.6% (range, 0% to 5.1%), tetralogy of Fallot (TOF) repair = 1.1% (range, 0% to 16.7%), complete atrioventricular canal repair (AVC) = 2.2% (range, 0% to 20%), arterial switch operation (ASO) = 2.9% (range, 0% to 50%), ASO + VSD = 7.0% (range, 0% to 100%), Fontan operation = 1.3% (range, 0% to 9.1%), truncus arteriosus repair = 10.9% (0% to 100%), and Norwood procedure = 19.3% (range, 0% to 100%). Funnel plots revealed that the number of centers characterized as outliers were VSD = 0, TOF = 0, AVC = 1, ASO = 3, ASO + VSD = 1, Fontan operation = 0, truncus arteriosus repair = 4, and Norwood procedure = 11. Power calculations showed that statistically meaningful comparisons of mortality rates between centers could be made only for the Norwood procedure, for which the Bayesian-estimated range (95% probability interval) after risk-adjustment was 7.0% (3.7% to 10.3%) to 41.6% (30.6% to 57.2%). Between-center variation in PLOS was analyzed for all operations and was larger for more complex operations. CONCLUSIONS: This analysis documents contemporary benchmarks for common pediatric cardiac surgical operations and the range of outcomes among centers. Variation was most prominent for the more complex operations. These data may aid in quality assessment and quality improvement initiatives.

Duke Scholars

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

December 2011

Volume

92

Issue

6

Start / End Page

2184 / 2191

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Respiratory System
  • Infant, Newborn
  • Infant
  • Humans
  • Heart Defects, Congenital
  • Databases, Factual
  • Child, Preschool
  • Child
  • Cardiac Surgical Procedures
 

Citation

APA
Chicago
ICMJE
MLA
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Jacobs, J. P., O’Brien, S. M., Pasquali, S. K., Jacobs, M. L., Lacour-Gayet, F. G., Tchervenkov, C. I., … Mavroudis, C. (2011). Variation in outcomes for benchmark operations: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg, 92(6), 2184–2191. https://doi.org/10.1016/j.athoracsur.2011.06.008
Jacobs, Jeffrey Phillip, Sean M. O’Brien, Sara K. Pasquali, Marshall Lewis Jacobs, Francois G. Lacour-Gayet, Christo I. Tchervenkov, Erle H. Austin, et al. “Variation in outcomes for benchmark operations: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database.Ann Thorac Surg 92, no. 6 (December 2011): 2184–91. https://doi.org/10.1016/j.athoracsur.2011.06.008.
Jacobs JP, O’Brien SM, Pasquali SK, Jacobs ML, Lacour-Gayet FG, Tchervenkov CI, et al. Variation in outcomes for benchmark operations: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg. 2011 Dec;92(6):2184–91.
Jacobs, Jeffrey Phillip, et al. “Variation in outcomes for benchmark operations: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database.Ann Thorac Surg, vol. 92, no. 6, Dec. 2011, pp. 2184–91. Pubmed, doi:10.1016/j.athoracsur.2011.06.008.
Jacobs JP, O’Brien SM, Pasquali SK, Jacobs ML, Lacour-Gayet FG, Tchervenkov CI, Austin EH, Pizarro C, Pourmoghadam KK, Scholl FG, Welke KF, Mavroudis C. Variation in outcomes for benchmark operations: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg. 2011 Dec;92(6):2184–2191.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

December 2011

Volume

92

Issue

6

Start / End Page

2184 / 2191

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Respiratory System
  • Infant, Newborn
  • Infant
  • Humans
  • Heart Defects, Congenital
  • Databases, Factual
  • Child, Preschool
  • Child
  • Cardiac Surgical Procedures