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Pediatric Cardiology

, Volume 29, Issue 4, pp 713–717 | Cite as

Hospital Mortality for Norwood and Arterial Switch Operations as a Function of Institutional Volume

  • Jennifer C. Hirsch
  • James G. Gurney
  • Janet E. Donohue
  • Achamyeleh Gebremariam
  • Edward L. Bove
  • Richard G. Ohye
Original Article

Abstract

Regionalization of complex surgical procedures to high-volume centers is a model for improving hospital survival. We analyzed the effect of institutional volume on hospital mortality for the Norwood and arterial switch operations (ASO) as representative high-complexity neonatal cardiac procedures. Analysis of discharge data from the 2003 Kids’ Inpatient Database (KID) was conducted. Association between institutional volume and in-hospital mortality was examined for the ASO or Norwood procedure. Logistic regression analysis was performed to calculate the probability of hospital mortality for both procedures.

Significant inverse associations between institutional volume and in-hospital mortality for the Norwood procedure (p ≤ 0.001) and the ASO (p = 0.006) were demonstrated. In-hospital mortality decreased for the ASO as institutional volume increased, with mortality rates of 9.4% for institutions performing two ASOs/year, 3.2% for 10 ASOs/year, and 0.8% for 20 ASOs/year. Similarly, in-hospital mortality rates for hypoplastic left heart syndrome were 34.8% for two Norwood procedures/year, 25.7% for 10 Norwood procedures/year, and 16.7% for 20 Norwood procedures/year. An inverse relation was observed between in-hospital mortality and institutional volume for ASO and the Norwood procedure. These results suggest that selective regionalization of complex neonatal cardiac procedures might result in significant improvement in hospital survival nationally.

Keywords

Neonatal cardiac surgery Arterial switch operation Norwood operation Hypoplastic left heart syndrome Transposition of the great arteries 

Notes

Acknowledgment

The project was supported by the Michigan Congenital Heart Outcomes Research and Discovery unit (M-CHORD) with intramural funds from the Department of Surgery, University of Michigan.

References

  1. 1.
    Agency for Healthcare Research and Quality (2003) Healthcare Cost and Utilization Project (HCUP). In: HCUP Kids’ Inpatient Database (KID) 2003. Agency for Healthcare Research and Quality, Rockville, MDGoogle Scholar
  2. 2.
    Allen SW, Gauvreau K, Bloom BT et al. (2003) Evidence-based referral results in significantly reduced mortality after congenital heart surgery. Pediatrics 112:24–28PubMedCrossRefGoogle Scholar
  3. 3.
    Ashburn DA, McCrindle BW, Tchervenkov CI et al. (2003) Outcomes after the Norwood operation in neonates with critical aortic stenosis or aortic valve atresia. J Thorac Cardiovasc Surg 125:1070–1082PubMedCrossRefGoogle Scholar
  4. 4.
    Berry JG, Cowley CG, Hoff CJ et al. (2006) In-hospital mortality for children with hypoplastic left heart syndrome after stage I surgical palliation: teaching versus nonteaching hospitals. Pediatrics 117:1307–1313PubMedCrossRefGoogle Scholar
  5. 5.
    Chang RK, Klitzner TS (2002) Can regionalization decrease the number of deaths for children who undergo cardiac surgery? A theoretical analysis. Pediatrics 109:173–181PubMedCrossRefGoogle Scholar
  6. 6.
    Checchia PA, McCollegan J, Daher N et al. (2005) The effect of surgical case volume on outcome after the Norwood procedure. J Thorac Cardiovasc Surg 129:754–759PubMedCrossRefGoogle Scholar
  7. 7.
    Gutgesell HP, Massaro TA, Kron IL (1994) The arterial switch operation for transposition of the great arteries in a consortium of university hospitals. Am J Cardiol 74:959–960PubMedCrossRefGoogle Scholar
  8. 8.
    Hannan EL, Kilburn H Jr, Racz M et al. (1994) Improving the outcomes of coronary artery bypass surgery in New York State. JAMA 271:761–766PubMedCrossRefGoogle Scholar
  9. 9.
    Hannan EL, Racz M, Kavey RE et al. (1998) Pediatric cardiac surgery: the effect of hospital and surgeon volume on in-hospital mortality. Pediatrics 101:963–969PubMedCrossRefGoogle Scholar
  10. 10.
    Hraska V, Podnar T, Kunovsky P et al. (2003) Is a learning curve for arterial switch operation in small countries still acceptable? Model for cooperation in Europe. Eur J Cardiothorac Surg 24:352–357PubMedCrossRefGoogle Scholar
  11. 11.
    Jenkins KJ, Newburger JW, Lock JE et al. (1995) In-hospital mortality for surgical repair of congenital heart defects: preliminary observations of variation by hospital caseload. Pediatrics 95:323–330PubMedGoogle Scholar
  12. 12.
    Lundstrom NR, Berggren H, Bjorkhem G et al. (2000) Centralization of pediatric heart surgery in Sweden. Pediatr Cardiol 21:353–357PubMedCrossRefGoogle Scholar
  13. 13.
    Norwood WI, Dobell AR, Freed MD et al. (1988) Intermediate results of the arterial switch repair. A 20-institution study. J Thorac Cardiovasc Surg 96:854–863PubMedGoogle Scholar
  14. 14.
    Sarris GE, Chatzis AC, Giannopoulos NM et al. (2006) The arterial switch operation in Europe for transposition of the great arteries: a multi-institutional study from the European Congenital Heart Surgeons Association. J Thorac Cardiovasc Surg 132:633–639PubMedCrossRefGoogle Scholar
  15. 15.
    Sollano JA, Gelijns AC, Moskowitz AJ et al. (1999) Volume-outcome relationships in cardiovascular operations: New York State, 1990–1995. J Thorac Cardiovasc Surg 117:419–428; discussion 428–430PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Jennifer C. Hirsch
    • 1
  • James G. Gurney
    • 2
  • Janet E. Donohue
    • 2
  • Achamyeleh Gebremariam
    • 2
  • Edward L. Bove
    • 1
  • Richard G. Ohye
    • 1
  1. 1.Department of Surgery, Section of Cardiac Surgery, Division of Pediatric Cardiovascular SurgeryUniversity of Michigan Medical CenterAnn ArborUSA
  2. 2.Department of Pediatrics, Child Health Evaluation and Research UnitUniversity of Michigan Medical CenterAnn ArborUSA

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