Sara K Pasquali1, Marshall L Jacobs2, Sean M O'Brien3, Xia He3, J William Gaynor4, Michael G Gaies5, Eric D Peterson3, Jennifer C Hirsch-Romano6, John E Mayer7, Jeffrey P Jacobs2. 1. Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, Ann Arbor, Michigan. Electronic address: pasquali@med.umich.edu. 2. Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Johns Hopkins All Children's Heart Institute, Saint Petersburg, Tampa, and Orlando, Florida; Florida Hospital for Children, Orlando, Florida. 3. Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina. 4. Division of Cardiothoracic Surgery, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. 5. Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, Ann Arbor, Michigan. 6. Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan. 7. Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Abstract
BACKGROUND: Accurate hospital outcome measures in congenital heart surgery are important to multiple initiatives. While methods have been developed to account for differences in procedural case-mix, characteristics patients bring into the operation that may also vary across hospitals and influence outcome have received less attention. We evaluated the impact of these characteristics in a large cohort. METHODS: Patients undergoing congenital heart surgery at centers participating in The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) with adequate data quality were included. Variation across hospitals in important patient characteristics was examined, and hospital operative mortality rates were compared with and without adjustment for patient characteristics. RESULTS: Overall, 86 centers (52,224 patients) were included. There was greater than twofold variation across hospitals for nearly all patient characteristics examined. For example, the proportion of a center's surgical population comprised of neonates ranged from 12.8% to 26.6% across hospitals; the proportion with a non-cardiac anomaly ranged from 0.7% to 5.0%. When hospital mortality rankings were evaluated based on "standard" (adjustment for differences in procedural case-mix alone) versus "full" models (adjustment for both differences in procedural case-mix and patient characteristics), 14.0% changed their ranking for mortality by 20 or greater positions, 34.9% of centers changed which mortality quartile they were classified in, and 14.0% changed their statistical classification (statistically higher, lower, or same-as-expected mortality). CONCLUSIONS: Characteristics of patients undergoing congenital heart surgery vary across centers and impact hospital outcomes assessment. Methods to assess outcomes and relative performance should account for these characteristics.
BACKGROUND: Accurate hospital outcome measures in congenital heart surgery are important to multiple initiatives. While methods have been developed to account for differences in procedural case-mix, characteristics patients bring into the operation that may also vary across hospitals and influence outcome have received less attention. We evaluated the impact of these characteristics in a large cohort. METHODS:Patients undergoing congenital heart surgery at centers participating in The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 to 2013) with adequate data quality were included. Variation across hospitals in important patient characteristics was examined, and hospital operative mortality rates were compared with and without adjustment for patient characteristics. RESULTS: Overall, 86 centers (52,224 patients) were included. There was greater than twofold variation across hospitals for nearly all patient characteristics examined. For example, the proportion of a center's surgical population comprised of neonates ranged from 12.8% to 26.6% across hospitals; the proportion with a non-cardiac anomaly ranged from 0.7% to 5.0%. When hospital mortality rankings were evaluated based on "standard" (adjustment for differences in procedural case-mix alone) versus "full" models (adjustment for both differences in procedural case-mix and patient characteristics), 14.0% changed their ranking for mortality by 20 or greater positions, 34.9% of centers changed which mortality quartile they were classified in, and 14.0% changed their statistical classification (statistically higher, lower, or same-as-expected mortality). CONCLUSIONS: Characteristics of patients undergoing congenital heart surgery vary across centers and impact hospital outcomes assessment. Methods to assess outcomes and relative performance should account for these characteristics.
Authors: F Lacour-Gayet; D Clarke; J Jacobs; J Comas; S Daebritz; W Daenen; W Gaynor; L Hamilton; M Jacobs; B Maruszsewski; M Pozzi; T Spray; G Stellin; C Tchervenkov; C Mavroudis And Journal: Eur J Cardiothorac Surg Date: 2004-06 Impact factor: 4.191
Authors: David M Shahian; Xia He; Jeffrey P Jacobs; J Scott Rankin; Eric D Peterson; Karl F Welke; Giovanni Filardo; Cynthia M Shewan; Sean M O'Brien Journal: Ann Thorac Surg Date: 2013-06-29 Impact factor: 4.330
Authors: Kathy J Jenkins; Kimberlee Gauvreau; Jane W Newburger; Thomas L Spray; James H Moller; Lisa I Iezzoni Journal: J Thorac Cardiovasc Surg Date: 2002-01 Impact factor: 5.209
Authors: John M Costello; Sara K Pasquali; Jeffrey P Jacobs; Xia He; Kevin D Hill; David S Cooper; Carl L Backer; Marshall L Jacobs Journal: Circulation Date: 2014-05-02 Impact factor: 29.690
Authors: David M Overman; Jeffrey P Jacobs; Richard L Prager; Cameron D Wright; David R Clarke; Sara K Pasquali; Sean M O'Brien; Rachel S Dokholyan; Paul Meehan; Donna E McDonald; Marshall L Jacobs; Constantine Mavroudis; David M Shahian Journal: World J Pediatr Congenit Heart Surg Date: 2013-01
Authors: Sean M O'Brien; David R Clarke; Jeffrey P Jacobs; Marshall L Jacobs; Francois G Lacour-Gayet; Christian Pizarro; Karl F Welke; Bohdan Maruszewski; Zdzislaw Tobota; Weldon J Miller; Leslie Hamilton; Eric D Peterson; Constantine Mavroudis; Fred H Edwards Journal: J Thorac Cardiovasc Surg Date: 2009-11 Impact factor: 5.209
Authors: Michael Gaies; David S Cooper; Sarah Tabbutt; Steven M Schwartz; Nancy Ghanayem; Nikhil K Chanani; John M Costello; Ravi R Thiagarajan; Peter C Laussen; Lara S Shekerdemian; Janet E Donohue; Gina M Willis; J William Gaynor; Jeffrey P Jacobs; Richard G Ohye; John R Charpie; Sara K Pasquali; Mark A Scheurer Journal: Cardiol Young Date: 2014-08-28 Impact factor: 1.093
Authors: Matthew J Strickland; Tiffany J Riehle-Colarusso; Jeffrey P Jacobs; Mark D Reller; William T Mahle; Lorenzo D Botto; Paige E Tolbert; Marshall L Jacobs; Francois G Lacour-Gayet; Christo I Tchervenkov; Constantine Mavroudis; Adolfo Correa Journal: Cardiol Young Date: 2008-12 Impact factor: 1.093
Authors: Christopher L Curzon; Sarah Milford-Beland; Jennifer S Li; Sean M O'Brien; Jeffrey Phillip Jacobs; Marshall Lewis Jacobs; Karl F Welke; Andrew J Lodge; Eric D Peterson; James Jaggers Journal: J Thorac Cardiovasc Surg Date: 2008-01-18 Impact factor: 5.209
Authors: Michael Gaies; David K Werho; Wenying Zhang; Janet E Donohue; Sarah Tabbutt; Nancy S Ghanayem; Mark A Scheurer; John M Costello; J William Gaynor; Sara K Pasquali; Justin B Dimick; Mousumi Banerjee; Steven M Schwartz Journal: Ann Thorac Surg Date: 2017-10-05 Impact factor: 4.330
Authors: Tiffany J Riehle-Colarusso; Lisa Bergersen; Craig S Broberg; Cynthia H Cassell; Darryl T Gray; Scott D Grosse; Jeffrey P Jacobs; Marshall L Jacobs; Russell S Kirby; Lazaros Kochilas; Asha Krishnaswamy; Arianne Marelli; Sara K Pasquali; Thalia Wood; Matthew E Oster Journal: J Am Heart Assoc Date: 2016-10-26 Impact factor: 5.501