107. Public Reporting of Congenital Cardiac Surgery Outcomes Based on Common Congenital Heart Operations
WVU Medicine Children's Hospital
Morgantown, WV
United States - Contact Me
Christopher E. Mascio, MD is Executive Director of WVU Medicine Children's Heart Center and Professor and Chief, Division of Pediatric Cardiothoracic Surgery, WVU School of Medicine in Morgantown, WV. He has been practicing for over 15 years and performs the full spectrum of congenital heart operations from neonates to adults with congenital heart disease.
Boston Children's Hospital
Watertown, MA
United States - Contact Me
I am a pediatric cardiac surgeon at Boston Children’s Hospital, primarily involved in clinical research. I have over 15 years of research experience encompassing the period of my residency training and current faculty position. Having successfully graduated with an MPH from the Harvard TH Chan School of Public Health in clinical effectiveness, my area of excellence is clinical investigation. After early work in basic science examining the role of mitochondria in cardiac hypertrophy and failure, supported by the Thoracic Surgery Foundation's Nina Braunwald research fellowship, I transitioned to clinical outcomes research, particularly validation of the Residual Lesion Score (RLS) as a quality assessment initiative in congenital cardiac surgery. This 17-center project was supported by the Braunwald Research Award, a K23 grant from the NHLBI and a UO1 grant through the Pediatric Heart Network. My primary research focus remains clinical outcomes and quality improvement in congenital cardiac surgery, particularly in understanding residual lesions and their impact on outcomes after congenital cardiac surgery. I have collaborated with researchers in my hospital and across centers in the US and internationally to understand modifiable factors that determine outcomes after pediatric heart surgery.
Description
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.