Full Citation
Title: Procedure-specific center volume and mortality following infantile congenital heart surgery
Citation Type: Journal Article
Publication Year: 2023
ISBN:
ISSN: 0003-4975
DOI: 10.1016/J.ATHORACSUR.2023.04.020
NSFID:
PMCID:
PMID: 37100164
Abstract: <h2>ABSTRACT</h2><h3>BACKGROUND</h3><p>Regionalization of congenital heart surgery (CHS) has been proposed to improve post-surgical outcomes by increasing experience in the care of high-risk patients. We sought to determine whether procedure-specific center volume was associated with mortality following infantile CHS up to 3 years following surgery.</p><h3>METHODS</h3><p>We analyzed data from 12,263 infants in the Pediatric Cardiac Care Consortium undergoing CHS between 1982 and 2003 at 46 centers within the United States. We used logistic regression to assess the association between procedure-specific center volume and mortality from discharge to 3 years post-procedure, accounting for clustering at the center level and adjusting for patient age and weight at surgery, chromosomal abnormality, and surgical era.</p><h3>RESULTS</h3><p>We found decreased odds for in-hospital mortality for Norwood procedures (OR = 0.955, 95% CI=0.935-0.976), arterial switch operations (OR=0.924, 95% CI=0.889-0.961), tetralogy of Fallot repairs (OR=0.975, 95% CI=0.956-0.995), Glenn shunts (OR=0.971, 95% CI=0.943-1.000) and ventricular septal defect closures (OR=0.974, 95% CI=0.964-0.985). The association persisted up to three years post-surgery for Norwood procedures (OR=0.971, 95% CI=0.955-0.988), arterial switches (OR=0.929, 95% CI=0.890-0.970), and ventricular septal defect closures (OR=0.986, 95% CI=0.977-0.995); however, after excluding deaths which occurred within the first 90 days of following surgery, we observed no association between center volume and mortality for any of the procedures studied.</p><h3>CONCLUSIONS</h3><p>These findings suggest that procedure-specific center volume is inversely associated with early postoperative mortality for infantile CHS across the complexity spectrum but has no measurable effect on later mortality.</p>
Url: http://www.annalsthoracicsurgery.org/article/S0003497523004022/fulltext
Url: http://www.annalsthoracicsurgery.org/article/S0003497523004022/abstract
Url: https://www.annalsthoracicsurgery.org/article/S0003-4975(23)00402-2/abstract
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Authors: Zmora, Rachel; Spector, Logan; Bass, John; Thomas, Amanda; Knight, Jessica; Lakshminarayan, Kamakshi; St Louis, James; Kochilas, Lazaros; Louis, St J
Periodical (Full): The Annals of Thoracic Surgery
Issue: 0
Volume: 0
Pages:
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