Abstract
Studies have shown improved perioperative outcomes after neonatal heart surgery at centers with greater surgical volumes. The impact of increasing distance from such centers on outcome after discharge has not yet been reported. Chart review and cross-sectional survey were performed on children discharged or transferred after undergoing neonatal congenital heart surgery as neonates (<30 days of age) from January 2005 to June 2006. The association of distance from center with mortality and adverse events was analyzed by univariate and multivariate regression and stratified by the Risk Adjustment for Congenital Heart Surgery-1 for complexity. Among 217 patients, those living further from the surgical center were smaller and older at surgery and more likely to be RACHS-1 class 6. Overall mortality was 8% (16 of 202) and was not associated with distance. Surveys were completed by 109 (54%) families with mean follow-up of 24 (±3) months. Unplanned admissions after discharge and unplanned interventions occurred in 45% and 40% of patients, respectively. After adjusting for case complexity, living 90–300 min away from the surgical center was associated with fewer unplanned admissions compared with those living <90 min away. After neonatal cardiac surgery, adverse events were common. Distance from the surgical center was not associated with mortality, but it was associated with morbidity in a nonlinear fashion. This relation, its mediators, and its possible impact on mortality and later outcomes warrant further study to aid in planning appropriate patient follow-up.
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Al-Radi OO, Harrell FE Jr, Caldarone CA, McCrindle BW, Jacobs JP, Williams MG et al (2007) Case complexity scores in congenital heart surgery: a comparative study of the Aristotle Basic Complexity score and the Risk Adjustment in Congenital Heart Surgery (RACHS-1) system. J Thorac Cardiovasc Surg 133(4):865–875
Bazzani LG, Marcin JP (2007) Case volume and mortality in pediatric cardiac surgery patients in California, 1998–2003. Circulation 115(20):2652–2659
Chang RK, Klitzner TS (2002) Can regionalization decrease the number of deaths for children who undergo cardiac surgery? A theoretical analysis. Pediatrics 109(2):173–181
Chang RK, Rodriguez S, Lee M, Klitzner TS (2006) Risk factors for deaths occurring within 30 days and 1 year after hospital discharge for cardiac surgery among pediatric patients. Am Heart J 152(2):386–393
Checchia PA, McCollegan J, Daher N, Kolovos N, Levy F, Markovitz B (2005) The effect of surgical case volume on outcome after the Norwood procedure. J Thorac Cardiovasc Surg 129(4):754–759
Ferraris VA, Ferraris SP, Harmon RC, Evans BD (2001) Risk factors for early hospital readmission after cardiac operations. J Thorac Cardiovasc Surg 122(2):278–286
Finley CJ, Bendzsak A, Tomlinson G, Keshavjee S, Urbach DR, Darling GE (2010) The effect of regionalization on outcome in pulmonary lobectomy: a Canadian national study. J Thorac Cardiovasc Surg 140(4):757–763
Gregory PM, Malka ES, Kostis JB, Wilson AC, Arora JK, Rhoads GG (2000) Impact of geographic proximity to cardiac revascularization services on service utilization. Med Care 38(1):45–57
Hannan EL, Racz M, Kavey RE, Quaegebeur JM, Williams R (1998) Pediatric cardiac surgery: the effect of hospital and surgeon volume on in-hospital mortality. Pediatrics 101(6):963–969
Hehir DA, Dominguez TE, Ballweg JA, Ravishankar C, Marino BS, Bird GL, et al. (2008) Risk factors for interstage death after stage 1 reconstruction of hypoplastic left heart syndrome and variants. J Thorac Cardiovasc Surg 136(1):94–99, 99.e91–93
Hirsch JC, Gurney JG, Donohue JE, Gebremariam A, Bove EL, Ohye RG (2007) Hospital mortality for Norwood and arterial switch operations as a function of institutional volume. Pediatr Cardiol 29(4):713–717
Hoffman JI (1995) Incidence of congenital heart disease: II. Prenatal incidence. Pediatr Cardiol 16(4):155–165
Holloway M (2001) The regionalized perinatal care program. In: Isaacs S, James R (eds) To improve health and health care. Volume IV. The Robert Wood Johnson Foundation, Princeton, NJ
Jacobs JP, Mavroudis C, Jacobs ML, Lacour-Gayet FG, Tchervenkov CI, William Gaynor J et al (2004) Lessons learned from the data analysis of the second harvest (1998–2001) of the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database. Eur J Cardiothorac Surg 26(1):18–37
Jenkins KJ, Newburger JW, Lock JE, Davis RB, Coffman GA, Iezzoni LI (1995) In-hospital mortality for surgical repair of congenital heart defects: preliminary observations of variation by hospital caseload. Pediatrics 95(3):323–330
Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI (2002) Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 123(1):110–118
Kugler JD, Beekman RH III, Rosenthal GL, Jenkins KJ, Klitzner TS, Martin GR et al (2009) Development of a pediatric cardiology quality improvement collaborative: From inception to implementation. From the Joint Council on Congenital Heart Disease Quality Improvement Task Force. Congenit Heart Dis 4(5):318–328
Lorch SA, Silber JH, Even-Shoshan O, Millman A (2009) Use of prolonged travel to improve pediatric risk-adjustment models. Health Serv Res 44(2 Pt 1):519–541
Mackie AS, Gauvreau K, Newburger JW, Mayer JE, Erickson LC (2004) Risk factors for readmission after neonatal cardiac surgery. Ann Thorac Surg 78(6):1972–1978 discussion 1978
Mayer ML (2008) Disparities in geographic access to pediatric subspecialty care. Matern Child Health J 12(5):624–632
Moller JH, Allen HD, Clark EB, Dajani AS, Golden A, Hayman LL et al (1993) Report of the task force on children and youth. American Heart Association. Circulation 88(5 Pt 1):2479–2486
Morris CD, Menashe VD (1991) 25-year mortality after surgical repair of congenital heart defect in childhood. A population-based cohort study. JAMA 266(24):3447–3452
Piette JD, Moos RH (1996) The influence of distance on ambulatory care use, death, and readmission following a myocardial infarction. Health Serv Res 31(5):573–591
Schidlow DN, Anderson JB, Klitzner TS, Beekman RH III, Jenkins KJ, Kugler JD, et al (2011) Variation in interstage outpatient care after the Norwood procedure: a report from the Joint Council on Congenital Heart Disease National Quality Improvement Collaborative. Congenit Heart Dis 6(2):98–107
Smith PC, Powell KR (2002) Can regionalization decrease the number of deaths for children who undergo cardiac surgery? A theoretical analysis. Pediatrics 110(4):849–850 discussion 849–850
Sollano JA, Gelijns AC, Moskowitz AJ, Heitjan DF, Cullinane S, Saha T et al (1999) Volume-outcome relationships in cardiovascular operations: New York State, 1990–1995. J Thorac Cardiovasc Surg 117(3):419–428 discussion 428–430
Tilford JM, Simpson PM, Green JW, Lensing S, Fiser DH (2000) Volume-outcome relationships in pediatric intensive care units. Pediatrics 106(2 Pt 1):289–294
Wernovsky G, Rome JJ, Tabbutt S, Rychik J, Cohen MS, Paridon SM et al (2006) Guidelines for the outpatient management of complex congenital heart disease. Congenit Heart Dis 1(1–2):10–26
Acknowledgements
We thank Greg Stoddard, Section of Biostatistics, Division of Clinical Epidemiology, University of Utah School of Medicine, for his assistance and guidance with our analyses for this report.
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Pinto, N.M., Lasa, J., Dominguez, T.E. et al. Regionalization in Neonatal Congenital Heart Surgery: The Impact of Distance on Outcome After Discharge. Pediatr Cardiol 33, 229–238 (2012). https://doi.org/10.1007/s00246-011-0116-4
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DOI: https://doi.org/10.1007/s00246-011-0116-4