Variation in outcomes for risk-stratified pediatric cardiac surgical operations: An analysis of the STS congenital heart surgery database
Open accessAbstract
Background We evaluated outcomes for groups of risk-stratified operations in The Society of Thoracic Surgeons Congenital Heart Surgery Database to provide contemporary benchmarks and examine variation between centers.Methods Patients undergoing surgery from 2005 to 2009 were included. Centers with more than 10% missing data were excluded. Discharge mortality and postoperative length of stay (PLOS) among patients discharged alive were calculated for groups of risk-stratified operations using the five Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery mortality categories (STAT Mortality Categories). Power for analyzing between-center differences in outcome was determined for each STAT Mortality Category. Variation was evaluated using funnel plots and Bayesian hierarchical modeling.Results In this analysis of risk-stratified operations, 58,506 index operations at 73 centers were included. Overall discharge mortality (interquartile range among programs with more than 10 cases) was as follows: STAT Category 1=0.55% (0% to 1.0%), STAT Category 2=1.7% (1.0% to 2.2%), STAT Category 3=2.6% (1.1% to 4.4%), STAT Category 4=8.0% (6.3% to 11.1%), and STAT Category 5=18.4% (13.9% to 27.9%). Funnel plots with 95% prediction limits revealed the number of centers characterized as outliers by STAT Mortality Categories was as follows: Category 1=3 (4.1%), Category 2=1 (1.4%), Category 3=7 (9.7%), Category 4=13 (17.8%), and Category 5=13 (18.6%). Between-center variation in PLOS was analyzed for all STAT Categories and was greatest for STAT Category 5 operations.Conclusions This analysis documents contemporary benchmarks for risk-stratified pediatric cardiac surgical operations grouped by STAT Mortality Categories and the range of outcomes among centers. Variation was greatest for the more complex operations. These data may aid in the design and planning of quality assessment and quality improvement initiatives.
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In a multicenter study focusing exclusively on neonates, a VVR score ≥ 35 at 48 h post-surgery was more predictive of prolonged mechanical ventilation than VIS, the ventilation index (VI), or lactate levels.
“In a multicenter study focusing exclusively on neonates, a VVR score ≥ 35 at 48 h post-surgery was more predictive of prolonged mechanical ventilation than VIS, the ventilation index (VI), or lactate levels [46].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [46]
The Material and Methods > Analytic Methods passage identifies discharge mortality and postoperative length of stay as the study’s outcomes, not prolonged mechanical ventilation. Searches for VVR ≥35 at 48 hours, neonates, VIS, ventilation index, and lactate found no passage addressing the claimed prediction comparison. The cited paper’s copy therefore does not verify this claim. (LLM, conf=0.76)
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“In a multicenter study focusing exclusively on neonates, a VVR score ≥ 35 at 48 h post-surgery was more predictive of prolonged mechanical ventilation than VIS, the ventilation index (VI), or lactate levels [46].”
- Authors
- Jacobs, J. P., O'Brien, S. M., Pasquali, S. K., Jacobs, M. L., Lacour-Gayet, F. G., Tchervenkov, C. I., Austin, E. H., Pizarro, C., Pourmoghadam, K. K., Scholl, F. G., Welke, K. F., Gaynor, J. W., Clarke, D. R., Mayer, J. E., & Mavroudis, C.
- Affiliations
- University of South Florida (US)
- Duke University (US)
- Cleveland Clinic (US)
- Montreal Children's Hospital (CA)
- University of Louisville (US)
- Alfred I. duPont Hospital for Children (US)
- University of Oklahoma Health Sciences Center (US)
- Joe DiMaggio Children's Hospital (US)
- Seattle Children's Hospital (US)
- Children's Hospital of Philadelphia (US)
- University of Colorado Anschutz (US)
- Boston Children's Hospital (US)
- AdventHealth for Children (US)
- Corresponding author
- Jacobs, Jeffrey Phillip
- ORCID
- Venue
- The Annals of Thoracic Surgery
- Publisher
- Elsevier BV
- Published
- 2012-08
- Volume
- 94
- Issue
- 2
- Pages
- 564-572
- ISSN
- 0003-4975 (ISSN-L)
- PMC
- PMC4006082
- OpenAlex
- W2097421050
- Cited by
- 136
- References
- 14
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 6 · 2023: 14 · 2022: 4 · 2021: 13 · 2020: 7 · 2019: 7 · 2018: 7 · 2017: 9 · 2016: 18 · 2015: 5 · 2014: 18 · 2013: 12 · 2012: 2
- FWCI
- 8.86
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- The Annals of Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (K08HL103631)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Keywords
- pediatric cardiac surgery, congenital heart surgery, risk stratification, surgical outcomes, discharge mortality, postoperative hospital stay, quality standards, Society of Thoracic Surgeons Congenital Heart Surgery Database, quality improvement
- MeSH terms
- Adolescent, Child, Female, Heart Defects, Congenital, Heart Diseases, Cardiac Surgical Procedures, Humans, Male, Databases, Factual, Treatment Outcome, Risk Assessment, Benchmarking
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