Center Volume Impacts Readmissions and Mortality after Congenital Cardiac Surgery

To characterize the relationship between surgical volume and postoperative outcomes in congenital heart surgery, we used a national cohort to assess the costs, readmissions, and complications in children undergoing cardiac operations. The Nationwide Readmissions Database was used to identify pediatr...

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Veröffentlicht in:The Journal of pediatrics 2022-01, Vol.240, p.129-135.e2
Hauptverfasser: Williamson, Catherine G., Tran, Zachary, Kim, Samuel T., Hadaya, Joseph, Biniwale, Reshma, Benharash, Peyman
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container_end_page 135.e2
container_issue
container_start_page 129
container_title The Journal of pediatrics
container_volume 240
creator Williamson, Catherine G.
Tran, Zachary
Kim, Samuel T.
Hadaya, Joseph
Biniwale, Reshma
Benharash, Peyman
description To characterize the relationship between surgical volume and postoperative outcomes in congenital heart surgery, we used a national cohort to assess the costs, readmissions, and complications in children undergoing cardiac operations. The Nationwide Readmissions Database was used to identify pediatric patients (≤18 years) undergoing congenital cardiac surgery from 2010 to 2017. Hospitals were categorized based on deciles and tertiles of annual caseload with high-volume categorized as the highest tertile of volume. Multivariable regression models adjusting for patient and hospital characteristics were used to study the impact of volume on 30-day nonelective readmission, mortality, home discharge, and resource use. Of an estimated 69 448 hospitalizations included for analysis, 56 672 (82%) occurred at high-volume centers. After adjustment for key clinical factors, each decile increase in volume was associated with a 25% relative decrease in the odds of mortality, a 14% decrease in the odds of nonhome discharge, and a 4% relative decrease in the likelihood of 30-day nonelective readmission. After risk adjustment, each incremental increase in volume decile was associated with a one-half-day decrease in the hospital length of stay, but did not alter costs of the index hospitalization. However, after including all readmissions within 30 days of the index discharge, high-volume centers were associated with significantly lower costs compared with low-volume hospitals. Increased congenital cardiac surgery volume is associated with improved mortality, reduced duration of hospitalization, 30-day readmissions, and resource use. These findings demonstrate the inverse relationship between hospital volume and resource use and may have implications for the centralization of care for congenital cardiac surgery.
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subjects Adolescent
Cardiac Surgical Procedures
Child
Child, Preschool
Databases, Factual
Female
Heart Defects, Congenital - surgery
Hospitals, High-Volume
Hospitals, Low-Volume
Humans
Infant
Infant, Newborn
Length of Stay - statistics & numerical data
Male
Patient Readmission - statistics & numerical data
United States - epidemiology
title Center Volume Impacts Readmissions and Mortality after Congenital Cardiac Surgery
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