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Examining variation in interstage mortality rates across the National Pediatric Cardiology Quality Improvement Collaborative: do lower-mortality centres have lower-risk patients?

Published online by Cambridge University Press:  21 June 2018

Katherine E. Bates ,
Sunkyung Yu ,
Ray Lowery ,
Sara K. Pasquali ,
David W. Brown ,
Peter B. Manning  and
Karen Uzark
Katherine E. Bates*
Affiliation:
Department of Pediatrics and Communicable Diseases, Congenital Heart Center, C.S. Mott Children’s Hospital, Ann Arbor, MI, USA
Sunkyung Yu
Affiliation:
Department of Pediatrics and Communicable Diseases, Congenital Heart Center, C.S. Mott Children’s Hospital, Ann Arbor, MI, USA
Ray Lowery
Affiliation:
Department of Pediatrics and Communicable Diseases, Congenital Heart Center, C.S. Mott Children’s Hospital, Ann Arbor, MI, USA
Sara K. Pasquali
Affiliation:
Department of Pediatrics and Communicable Diseases, Congenital Heart Center, C.S. Mott Children’s Hospital, Ann Arbor, MI, USA
David W. Brown
Affiliation:
Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
Peter B. Manning
Affiliation:
Department of Surgery, Division of Cardiothoracic Surgery, St. Louis Children’s Hospital, St. Louis, MO, USA
Karen Uzark
Affiliation:
Department of Pediatrics and Communicable Diseases, Congenital Heart Center, C.S. Mott Children’s Hospital, Ann Arbor, MI, USA Department of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
*
Author for correspondence: K. E. Bates, MD MS, Congenital Heart Center, C.S. Mott Children’s Hospital, University of Michigan Medical School, 1540 E. Hospital Drive, Ann Arbor, MI 48109 4204, USA. Tel: 734 232 8426; Fax: 734 936 4628; E-mail: kebates@med.umich.edu
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Abstract

Background

Although interstage mortality for infants with hypoplastic left heart syndrome has declined within the National Pediatric Cardiology Quality Improvement Collaborative, variation across centres persists. It remains unclear whether centres with lower interstage mortality have lower-risk patients or whether differences in care may explain this variation. We examined previously established risk factors across National Pediatric Cardiology Quality Improvement Collaborative centres with lower and higher interstage mortality rates.

Methods

Lower-mortality centres were defined as those with >25 consecutive interstage survivors. Higher-mortality centres were defined as those with cumulative interstage mortality rates >10%, which is a collaborative historic baseline rate. Baseline risk factors and perioperative characteristics were compared.

Results

Seven lower-mortality centres were identified (n=331 patients) and had an interstage mortality rate of 2.7%, as compared with 13.3% in the four higher-mortality centres (n=173 patients, p<0.0001). Of all baseline risk factors examined, the only factor that differed between the lower- and higher-mortality centres was postnatal diagnosis (18.4 versus 31.8%, p=0.001). In multivariable analysis, there remained a significant mortality difference between the two groups of centres after adjusting for this variable: adjusted mortality rate was 2.8% in lower-mortality centres compared with 12.6% in higher-mortality centres, p=0.003. Secondary analyses identified multiple differences between groups in perioperative practices and other variables.

Conclusions

Variation in interstage mortality rates between these two groups of centres does not appear to be explained by differences in baseline risk factors. Further study is necessary to evaluate variation in care practices to identify targets for improvement efforts.

Keywords

CHDhypoplastic left heart syndromeNorwood operation
Type
Original Article
Information
Cardiology in the Young , Volume 28 , Issue 8 , August 2018 , pp. 1031 - 1036
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Copyright
© Cambridge University Press 2018 

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Footnotes

Cite this article: Bates KE, Yu S, Lowery R, Pasquali SK, Brown DW, Manning PB, Uzark K. (2018) Examining variation in interstage mortality rates across the National Pediatric Cardiology Quality Improvement Collaborative: do lower-mortality centres have lower-risk patients? Cardiology in the Young28: 1031–1036. doi: 10.1017/S1047951118000926

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