Cited by 136Congenital Heart Disease StudiesCardiac and Coronary Surgery TechniquesTransplantation: Methods and Outcomes

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Variation in Outcomes for Risk-Stratified Pediatric Cardiac Surgical Operations: An Analysis of the STS Congenital Heart Surgery Database

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Jacobs, Jeffrey Phillip, O'Brien, Sean M., Pasquali, Sara K., Jacobs, Marshall Lewis, Lacour-Gayet, François G., Tchervenkov, Christo I., Austin, Erle H., Pizarro, Christian, Pourmoghadam, Kamal K., Scholl, Frank G., Welke, Karl F., Gaynor, J. William, Clarke, David R., Mayer, John E., Mavroudis, Constantine·2012·The Annals of Thoracic Surgery

DOI 10.1016/j.athoracsur.2012.01.105PMC PMC4006082

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Abstract

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 [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: Jacobs, Jeffrey Phillip
Pasquali, Sara K.
Austin, Erle H.
Pizarro, Christian
Scholl, Frank G.
Welke, Karl F.
Gaynor, J. William
Mayer, John E.
Mavroudis, Constantine
Venue: The Annals of Thoracic Surgery
Publisher: Elsevier BV
Published: 2012-08
Volume: 94
Issue: 2
Pages: 564-572
ISSN: 0003-4975 (ISSN-L)
DOI: 10.1016/j.athoracsur.2012.01.105
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
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 › Cardiology and Cardiovascular Medicine › 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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Variation in Outcomes for Risk-Stratified Pediatric Cardiac Surgical Operations: An Analysis of the STS Congenital Heart Surgery Database

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