Center Volume Is Not Associated with Failure to Rescue in Pediatric Cardiac Surgery

D. Chauhan¹, J. Mehaffey², A. Hayanga², M. Mathewson¹, U. Kohli¹, A. Verhoeven¹, R. Natarajan¹, J. Udassi¹, V. Badhwar², C. Mascio^1
1WVU Medicine Children's Hospital, Morgantown, West Virginia ²West Virginia University, Morgantown, West Virginia

Purpose: Center volume has been endorsed as a metric of quality in pediatric cardiac surgery, however, it is unknown how this correlates with failure to rescue (FTR). We sought to assess the relationship between annual hospital case volume and failure to rescue after pediatric cardiac surgery using a national administrative database.

Methods: Hospital admissions for cardiopulmonary bypass (CPB) cases were extracted from the Kids’ Inpatient Database for the years 2016 and 2019. FTR was defined as inpatient mortality among patients who had at least one post-operative complication defined by the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS CHSD). Based on annual CPB case volume, hospitals were divided into high volume (>194 cases/year), mid-volume (104-193 cases/year) and low volume (≤103 cases/year) hospitals. A multilevel multivariable logistic model was created to evaluate the association of annual CPB case volume and FTR using covariates based on the STS CHSD risk model. A histogram was plotted for risk adjusted FTR by hospital volume groups. Taking mean adjusted FTR rate of the entire sample as baseline, hospitals were divided into high-performers if the FTR rate was lower than the mean and low-performers if the FTR rate was higher than the mean.

Results: Out of 25,749 encounters during the study period, 10,528 had one or more complications during the same admission. There were 134 hospitals in low-volume group, 64 hospitals in mid-volume group and 31 hospitals in high-volume group. The risk-adjusted FTR rate was 4.2% for the entire cohort: 4.15% for the low-volume hospitals, 4.23% for mid-volume hospitals and 4.33% for high-volume hospitals. Comparing with low-volume hospitals at baseline, multilevel multivariable logistic regression model demonstrated no statistically significant difference in FTR for mid-volume hospitals (OR 0.8, 95% CI 0.61-1.06, p=0.118) or high-volume hospitals (OR 0.79, 95% CI 0.59-1.08, p=0.131) compared to low volume. In the low volume hospital group, 57% overperformed (n=76) and 43% underperformed (n=58). In the mid-volume hospital group, 56% overperformed (n=36) and 44% of hospitals underperformed (n=28). In the high-volume hospital group, 39% overperformed (n=12) and 61% underperformed (n=19). (Figure 1).

Conclusion: This real-world contemporary analysis highlights that hospital volume is not associated with failure to rescue after pediatric cardiac surgery. Underperformers and overperformers exist in all volume groups. While center volume is important, failure to rescue after pediatric cardiac surgery might be a better marker of quality in pediatric cardiac surgery.

Identify the source of the funding for this research project: J. Hunter Mehaffey has received financial support from the National Institutes of Health (NIH) National Heart, Lung and Blood Institute (NHLBI)
(2UM1 HL088925 12). J. W. Awori Hayanga has received financial support from the NIH NHLBI (2UM1 HL088925 12). Vinay Badhwar has received
financial support from the NIH NHLBI (2UM1 HL088925 12)