The World Database For Pediatric And Congenital Heart Surgery (wdpchs): An International Quality Improvement Tool
James D. St. Louis, MD1, Sandre F. McNeal, MPH2, Jeffrey P. Jacobs, MD3, Jorge L. Cervantes, MD4, Nestor F. Sandoval, MD5, Krishna S. Iyer, MD6, Jagannath BR, MD7, Richard A. Jonas, MD8, Marshall L. Jacobs, MD9, Christo I. Tchervenkov, MD10, James K. Kirklin, MD11.
1Children Mercy Hospital, Kansas City, MO, USA, 2University of Alabama-Birmingham, Birmingham, AL, USA, 3Johns Hopkins All Children's Hospital, St Petersburg, FL, USA, 4Instituto Nacional de Cariologia, Mexico City, Mexico, 5Cirugia Cardiovascular, Bogota, Colombia, 6Fortis-Escorts Heart Institute, New Delhi, India, 7Star Hospital, Hyderabad, India, 8Children's National Health System, Washington, DC, USA, 9Johns Hopkins University, Balitmore, MD, USA, 10Montreal Children's Hospital, Montreal, QC, Canada, 11University of Alabama, Birmingham, AL, USA.
Objective(s):The holy grail of global quality assessment in congenital heart surgery through objective data has not yet been realized. The World Society for Pediatric and Congenital Heart Surgery has embraced this challenge with the creation of a WDPCHS, designed to provide a quality improvement tool for international centers.Methods:The WDPCHS collects data that reflect case mix, center outcomes, and adverse events. Cases are collected under one of two categories: Tier I, with extensive data collection and Tier II, with limited data submission. Center compliance is monitored with monthly data quality reports.
Results: Between 1/1/2017 and 1/1/2018, 3,860 procedures (1987 Tier1) were entered into the WDPCHS from 36 international congenital heart programs. During the first quarter of 2018, 2462 additional procedures (1461 Tier1) were added to the database from 42 centers. VSD and TOF were the most frequent diagnoses, comprising 54% of cases. Tier 1 discharge mortality during first year of data collection was 5% (70% CI: 4.5-5.5). The most common causes of post-operative mortality were cardiac failure, respiratory failure and sepsis. Among the 747 in-hospital complications in 428 patients (21% of Tier I cohort), the most common were cardiac dysfunction, respiratory failure, chylothorax, and arrhythmias.Conclusions:The WDPCHS provides a platform for effective quality improvement in congenital heart programs across the globe. Societal engagement is evident by the 900% increase in case enrollment from year 1 to year 2 (annualized). Database analyses will provide a continuing opportunity for research and outcomes improvement, regardless of center resources or experience.
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