Utilizing Real-Time Data from the Society of Thoracic Surgeons Congenital Heart Surgery Database to Improve Institutional Outcomes Following Congenital Heart Surgery

C. L.. Hancock Friesen¹, A. McGlinchey², T. L'Heureux², A. Ibrahimiye³, E. Kerns², L. Ortmann², R. Subramanyan^1
1University of Nebraska Medical Center, Omaha, Nebraska ²Children's Nebraska, Omaha, Nebraska ³Univeristy of Nebraska Medical Center, Omaha, Nebraska

Purpose: Reducing complications is the current horizon for improving quality of care in pediatric cardiac surgery1,2. We describe using local Society of Thoracic Surgery (STS) Congenital Heart Surgery Database (CHSD) data for real-time tracking of outcomes including mortality, major morbidity and length of stay.

Methods: STS CHSD data are abstracted from charts and input into third-party software used to submit data to the STS warehouse by a dedicated data analyst. A regularly refreshed Dashboard was created using data elements from the current CHSD data collection form to populate a series of reporting tables. PowerBi was employed to create visualizations of key data including mortality (Heart Center Dashboard). Weekly Collaborative Multidisciplinary Assessment of Performance (CMAP) rounds were instituted in July 2023 using the local STS CHSD data to create plots of risk-versus-time to depict the clinical course of each surgical patient and focus discussion on system-level issues. Risk adjusted outcome measures were utilized as defined by the Pediatric Cardiac Critical Care Consortium (PC4). We compared outcome metrics for the three quarters preceding the institution of the CMAP rounds and the deployment of the Heart Center Dashboard to the three quarters following institution.

Results: In the six quarters around institution of CMAP rounds and Heart Center Dashboard (Oct 1, 2022-Mar 31, 2024) there were 360 index procedures performed (total 700 procedures) with complexity distribution as follows: 54% STAT 1, 16% STAT 2, 13% STAT 3, 12% STAT 4 and 3.9% STAT 5. At least one STS defined complication occurred in 258 cases (72%) and at least one major STS defined complication in 63 cases (18%). Using PC4 risk adjusted outcomes and comparing the quarter immediately prior to implementation of CMAP rounds and Heart Center Dashboard (Q2 2023, Fig 1, Table 1) to the most recent available data (three quarters after implementation, Q1 2024) adjusted mortality rates were similar (preimplementation 1.27% (O:E 0.5) vs postimplementation 1.18% (0:E 0.46)). Failure to rescue rates were also similar (preimplementation 4.24% (O:E 0.59) vs postimplementation 3.87% (O:E 0.54). There were trends to improved outcomes in all other reported morbidity except postoperative major complication (preimplementation 6.46% (O:E 0.64) vs postimplementation (9.5% (O:E 0.94), postoperative stroke (preimplementation 2.03% (O:E 1.25) vs postimplementation 3.64% (O:E 2.23)) and postoperative seizure (preimplementation 0 vs postimplementation 1.64% (O:E 0.81).

Conclusion: Our data demonstrate the feasibility and power of utilizing real-time STS CHSD data to analyze outcome metrics following congenital heart surgery. Although the impact of unmeasured programmatic changes cannot be discounted, our results demonstrate that a focused data-driven review can improve overall outcomes.

Identify the source of the funding for this research project: N/A