Anesthesia Experts

Heart surgery outcomes comparable at high- and low-volume children’s hospitals

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Author: Michael Walter
Cardiovascular Business

High-volume pediatric heart surgery centers do not always achieve the best outcomes, according to new research presented at STS 2024, the annual meeting of the Society of Thoracic Surgeons (STS). Likewise, some low-volume centers deliver outcomes as good as anywhere in the world.

The analysis was based on nearly 26,000 heart surgeries performed at 235 different pediatric hospitals throughout the United States. Only “on-pump” procedures were counted, meaning each one involved the use of a cardiopulmonary bypass machine.

Hospitals that perform fewer than 103 procedures per year were viewed as “low-volume” centers for the sake of this research. Hospitals performing 104 to 194 procedures per year were viewed as “mid-volume” centers, and those that perform more than 194 procedures per year were viewed as “high-volume” centers.

“Contrary to conventional wisdom regarding the relationship between institutional volume and quality outcomes, there are high-performing low-volume centers in pediatric cardiac surgery for even the most complex operations,” senior author Christopher Mascio, MD, a pediatric cardiothoracic surgeon, professor and executive director at WVU Medicine Children’s Heart Center, said in a statement. “There are also underperforming high-volume programs. Judging program quality is more complex than a single volume number.”

Mascio et al. noted that all three groups—low-volume centers, mid-volume centers and high-volume centers—featured hospitals with unexpectedly low and unexpectedly high mortality rates. In fact, when examining mortality rates for six different benchmark procedures, the researchers found that there was no statistically significant difference between the three groups. The six benchmark procedures were tetralogy of Fallot repair, arterial switch with ventricular septal defect (VSD), arterial switch without VSD, Glenn and Fontan procedures and truncus arteriosus repair.

“When parents consider which center is best for their child, there are many other factors at play, including care team coordination, proximity, surgical team, and personal interactions,” Mascio added in the same statement. “The time is ripe for the congenital community to develop better methods for evaluating program quality. We hope this contribution provides a nidus for continued discussion around this issue, providing a voice to programs of all sizes.”

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