Public Reporting of Congenital Cardiac Surgery Outcomes Based on Common Congenital Heart Operations
Presented During:
Sunday, May 7, 2023: 7:30AM - 7:45AM
Los Angeles Convention Center
Posted Room Name:
403B
Abstract No:
107
Submission Type:
Abstract Submission
Authors:
Meena Nathan (1), Kimberlee Gauvreau (1), Owen White (2), Brett Anderson (3), Emile Bacha (3), David Barron (4), John Cleveland (5), Pedro J. del Nido (1), Pirooz Eghtesady (6), Mark Galantowicz (7), Diane Hersey (7), Andrea T Kennedy (8), Katherine Kohlsaat (1), Michael Ma (9), Charlene Mattila (4), Glen Van Arsdell (10), J. William Gaynor (8)
Institutions:
(1) Boston Children's Hospital, Boston, MA, (2) CardioAccess Inc, Ft. Lauderdale, FL, (3) New York-Presbyterian, New York, NY, (4) Hospital for Sick Children, TORONTO, ON, (5) Children's Hospital of Los Angeles, Los Angeles, CA, (6) St Louis Childrens, St. Louis, MO, (7) Nationwide Children's Hospital, Columbus, OH, (8) The Children's Hospital Of Philadelphia, Philadelphia, PA, (9) Lucile Packard Children's Hospital, Stanford, CA, (10) UCLA Ronald Reagan Medical Center, LOS ANGELES, CA
Submitting Author:
*Meena Nathan
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Boston Children's Hospital
Boston Children's Hospital
Co-Author(s):
Kimberlee Gauvreau
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Boston Children's Hospital
Boston Children's Hospital
Owen White
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CardioAccess Inc
CardioAccess Inc
Brett Anderson
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New York-Presbyterian
New York-Presbyterian
*Emile Bacha
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New York-Presbyterian
New York-Presbyterian
*David Barron
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Hospital for Sick Children
Hospital for Sick Children
John Cleveland
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Children's Hospital of Los Angeles
Children's Hospital of Los Angeles
*Pedro del Nido
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Boston Children's Hospital
Boston Children's Hospital
*Pirooz Eghtesady
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St Louis Childrens
St Louis Childrens
*Mark Galantowicz
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Nationwide Children's Hospital
Nationwide Children's Hospital
Diane Hersey
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Nationwide Children's Hospital
Nationwide Children's Hospital
Andrea T Kennedy
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The Children's Hospital Of Philadelphia
The Children's Hospital Of Philadelphia
Katherine Kohlsaat
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Boston Children's Hospital
Boston Children's Hospital
♦Michael Ma
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Lucile Packard Children's Hospital
Lucile Packard Children's Hospital
Charlene Mattila
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Hospital for Sick Children
Hospital for Sick Children
*Glen Van Arsdell
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UCLA Ronald Reagan Medical Center
UCLA Ronald Reagan Medical Center
*J. William Gaynor
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The Children's Hospital Of Philadelphia
The Children's Hospital Of Philadelphia
Presenting Author:
*Meena Nathan
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Boston Children's Hospital
Boston Children's Hospital
Abstract:
Objective: Ideal reporting of outcomes in congenital heart surgery requires accommodating multiple stakeholders: surgeons, cardiologists, parents, and hospital leadership. The report must be easily understandable and compare homogeneous groups of patients. We sought to develop a system of reporting that can meet these needs.
Methods: For this proof-of-concept project, we selected 19 commonly performed procedures ranging in complexity from the Norwood procedure to repair of atrial septal defects (ASD). To ensure the homogeneity of data and the creation of standard risk cohorts for each of the 19 procedures, we developed strict inclusion and exclusion criteria that encompassed diagnosis, procedure performed, prior interventions, and combination procedures. Preoperative, procedural, and postoperative data were collected for consecutive eligible patients from 8 centers between 1/1/2016 to 12/31/2021. Unadjusted mortality rates (mortality at hospital discharge or within 30 days if discharged home within 30 days) for each of the 19 procedures were analyzed in aggregate and stratified by each center.
Results: A total of 7979 patients were included from 8 centers with the number of cases for each procedure ranging from 75 for tetralogy of Fallot repair after prior palliation to 1104 for ventricular septal defect repairs (Figure). In aggregate, the unadjusted mortality ranged from 0% for ASD repair to 25.3% for Hybrid Stage I. There was significant heterogeneity in case volumes and unadjusted mortality for the different procedural categories across sites (e.g., ASO/VSD n=7 to 42, mortality 0% to 7%; Hybrid n=1 to 41, mortality 0% to 43%).
Conclusion: Reporting of institutional case volumes and outcomes, albeit unadjusted, within homogenous procedural categories will enable centers to benchmark their outcomes, better understand trends in mortality, and provides direction for improvement. Such analyses, when made public, will provide parents with information on a wide variety of specific operations. Including volumes of common operations will allow them to better understand each institution's experience with each operation. Future analysis will include adjustment for preoperative and patient-specific factors, which may allow for the development of prediction tools for outcomes that can aid counseling and setting of expectations not only for parents but also for the entire care team.
Methods: For this proof-of-concept project, we selected 19 commonly performed procedures ranging in complexity from the Norwood procedure to repair of atrial septal defects (ASD). To ensure the homogeneity of data and the creation of standard risk cohorts for each of the 19 procedures, we developed strict inclusion and exclusion criteria that encompassed diagnosis, procedure performed, prior interventions, and combination procedures. Preoperative, procedural, and postoperative data were collected for consecutive eligible patients from 8 centers between 1/1/2016 to 12/31/2021. Unadjusted mortality rates (mortality at hospital discharge or within 30 days if discharged home within 30 days) for each of the 19 procedures were analyzed in aggregate and stratified by each center.
Results: A total of 7979 patients were included from 8 centers with the number of cases for each procedure ranging from 75 for tetralogy of Fallot repair after prior palliation to 1104 for ventricular septal defect repairs (Figure). In aggregate, the unadjusted mortality ranged from 0% for ASD repair to 25.3% for Hybrid Stage I. There was significant heterogeneity in case volumes and unadjusted mortality for the different procedural categories across sites (e.g., ASO/VSD n=7 to 42, mortality 0% to 7%; Hybrid n=1 to 41, mortality 0% to 43%).
Conclusion: Reporting of institutional case volumes and outcomes, albeit unadjusted, within homogenous procedural categories will enable centers to benchmark their outcomes, better understand trends in mortality, and provides direction for improvement. Such analyses, when made public, will provide parents with information on a wide variety of specific operations. Including volumes of common operations will allow them to better understand each institution's experience with each operation. Future analysis will include adjustment for preoperative and patient-specific factors, which may allow for the development of prediction tools for outcomes that can aid counseling and setting of expectations not only for parents but also for the entire care team.
CONGENTIAL:
Neonatal and Pediatric Cardiac Surgery
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