Published online before print November 7, 2008, doi: 10.1161/CIRCULATIONAHA.108.776963
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(Circulation. 2008;118:2345-2352.)
© 2008 American Heart Association, Inc.
Congenital Heart Disease |
National Practice Patterns for Management of Adult Congenital Heart Disease
Operation By Pediatric Heart Surgeons Decreases In-Hospital Death
From the Department of Cardiothoracic Surgery, University of Michigan, Ann Arbor (T.K.), and Department of Surgery (B.S.D., T.P.) and Division of Pediatric Cardiothoracic Surgery, Department of Surgery (R.M.U., K.F.W.), Oregon Health and Science University, Portland.
Correspondence to Dr Tara Karamlou, University of Michigan, Department of Cardiothoracic Surgery, 1500 E Medical Center Dr, 5144 Cardiovascular Center, SPC 5864, Ann Arbor, MI 48109. E-mail tarakara{at}med.umich.edu
Received March 24, 2008; accepted September 4, 2008.
Background— Surgery for grown-up (age 
18 years) patients with congenital heart disease (GUCH) is frequently performed by surgeons without specialization in pediatric heart surgery. We sought to define national practice patterns and to determine whether outcomes for GUCH patients are improved if they are treated by specialized pediatric heart surgeons (PHSs) compared with non-PHSs.
Methods and Results— We identified index cardiac procedures in patients with 12 congenital heart disease diagnostic groups using the Nationwide Inpatient Sample 1988 to 2003. PHSs were defined as surgeons whose annual practice volumes were made of >75% annual pediatric heart cases. GUCH operations were defined as operations within these 12 diagnoses occurring in patients 18 years of age. We identified 30 250 operations, yielding a national estimate of 152 277±7875 operations. Of these, 111 816±7456 (73%) were pediatric operations, and 40 461±1365 (27%) were GUCH operations. PHSs performed 68% of pediatric operations in all diagnostic groups, whereas non-PHSs performed 95% of GUCH operations within the same diagnostic groups (P<0.0001). In-hospital death rates for GUCH patients operated on by PHSs were lower than death rates for GUCH patients operated on by non-PHSs (1.87% [95% CI, 0.62 to 3.13] versus 4.84% [95% CI, 4.30 to 5.38%]; P<0.0001). Survival advantage increased with increasing surgeon annual pediatric volume (P=0.0031).
Conclusions— Pediatric patients within specific diagnostic groups are more likely to undergo operation by PHSs, whereas GUCH patients within the same diagnostic groups are more likely to undergo operation by non-PHSs. In-hospital death rates are lower for GUCH patients operated on by PHSs. GUCH patients should be encouraged to obtain surgical operation by PHS.
CLINICAL PERSPECTIVE
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