Ped Heart Surgery Deaths Higher at Low Volume Centers

But no association found between center volume and rate of post-op complications

MONDAY, Jan. 9 (HealthDay News) -- Postoperative mortality rates from complications after pediatric heart surgery are higher at centers with a lower volume of cases, according to a study published online Jan. 9 in Pediatrics.

Sara K. Pasquali, M.D., of the Duke University Medical Center in Durham, N.C., and colleagues performed a multicenter analysis, including 35,776 children aged 0 to 18, to determine the relationship between annual patient volume and rates of complications and deaths in pediatric heart surgery. Outcomes were evaluated at 68 centers participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2006 to 2009).

The researchers found that 40.6 percent of in-hospital pediatric patients undergoing heart surgery had at least one complication, with an overall mortality rate of 3.9 percent. However, the mortality rate rose to 9 percent for postoperative patients with a complication, and lower volume centers had a greater mortality rate among this group, especially in the higher surgical risk categories. When volume was examined as a continuous variable, the odds ratio for postoperative mortalities in centers with fewer than 150 pediatric heart surgeries versus centers with more than 350 annually was 1.59. No relationship was found between center volume and the rate of postoperative complications.

"These data suggest that in addition to focusing on reducing complications themselves, quality improvement in the pediatric cardiac surgery population may also require attention to initiatives aimed at recognition and management of complications once they occur," the authors write.

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