Variation In Volume Outcome Relationship Across Hospitals Performing Arterial Switch Operation In The United States
Dhaval Chauhan, MD, J Hunter Mehaffey, MD MSc, J W. Hayanga, MD, Jai P. Udassi, MD, Vinay Badhwar, MD, Christopher E. Mascio, MD.
West Virginia University, Morgantown, WV, USA.
Objective(s):Lower hospital case volume has been shown to have worse outcomes in children undergoing heart surgery. This study explores the variation in mortality rates within hospitals performing the arterial switch operation (ASO) by their annual case volume. Methods:The Kids' Inpatient Database was examined for years 2016 and 2019 for hospitals performing pediatric cardiac surgery in the United States. A multivariable logistic regression model was created to obtain risk adjusted in-hospital mortality and compared by volume tertiles. Adjusted mortality rates were derived for hospitals performing ASO without ventricular septal defect repair. Histograms were plotted for each volume group by adjusted mortality rates. Results:There were 651 ASO performed in 163 hospitals. Hospitals were stratified by cardiopulmonary bypass case volume: 75 hospitals in the low-volume group (≤103 cases/yr), 58 hospitals in the mid-volume group (104-194 cases/yr), and 30 hospitals in the high-volume group (>194 cases/yr). The mean risk-adjusted hospital mortality for the entire sample was 2.66%. All three tertiles had underperforming hospitals (mortality rate >2.66%) and overperforming hospitals (mortality ≤2.66%). In the low-volume group, 37 (49%) hospitals had below average mortality rates (Figure 1).
Conclusions:This real world, risk-adjusted volume outcome analysis highlights that volume alone does not predict quality of ASO outcomes in the United States. Under performance existed in all volume tertiles. Using case volume alone as a surrogate for quality may unfairly asperse high-performing low-volume programs.
Back to 2023 Abstracts