Abstract 1909: In-hospital Mortality for Surgical Repair of Congenital Heart Defects is Inversely Related to Hospital Surgical Volume
The importance of surgical volume for procedures for Congenital Heart Defects (CHD) remains controversial. The Pediatric Cardiac Care Consortium (PCCC) database contains information on all pediatric cardiac procedures performed at over 40 member institutions. We used surgical outcome data from the PCCC to examine whether surgical volume is a determinant of center-specific differences in surgical mortality for CHD. The relationship between in-hospital mortality and surgical volume was examined in this retrospective cohort study from 29 centers within the PCCC. The outcomes of 22,148 consecutive surgical procedures for CHD between 2000 –2004 were reviewed. Nine centers performed <100 procedures/year, 10 centers 101–200 procedures/year, 7 centers 201–290 and 3 centers > 290 procedures/year. Cases were grouped into 4 categories based on the complexity of the procedure as assessed by the Risk Adjustment for Congenital Heart Surgery (RACHS) method to adjust for risk differences and allow meaningful comparisons of in-hospital mortality. The number of operations by risk category was the following: RACHS 1–2 (n=10,649), RACHS 3 (n=6,575), RACHS 4 (n=1,433) and RACHS 5– 6 (n=710). After applying logarithmic transformation, regression analysis revealed a significant (p=0.0001) inverse relation between in-hospital mortality and surgical volume, as shown in the figure⇓, and the regression curve’s formula has been estimated. Similar significant inverse behavior was found after grouping the surgeries by risk category.