Abstract 11485: New Metrics of Postoperative Mechanical Ventilation Duration After Congenital Heart Surgery Reveal Variation Across Hospitals

Abstract

Background: Pediatric cardiac surgical programs aim to limit duration of postoperative mechanical ventilation (POMV) to reduce complications and hospital stay. Measuring casemix-adjusted duration of POMV across hospitals might elucidate differential performance and identify improvement opportunities. Methods: All surgical hospitalizations in the Pediatric Cardiac Critical Care Consortium (PC 4 ) clinical registry from 10/2013-8/2015 were used to create a model predicting casemix-adjusted total duration of POMV using zero-inflated negative binomial regression and validated with 1000 bootstrap samples. From the model we developed metrics based on observed-to-expected POMV: early extubation success/failure, POMV reduction, and total hours of POMV saved/lost ( Table 1 ). We ranked hospitals on each metric (1-15, 1=best) and calculated an average ranking across metrics to identify high and low performing hospitals. Results: The cohort included 4739 hospitalizations from 15 hospitals: 53% were infants and 22% had high complexity surgery. The final model included age, weight-for-age z-score, prematurity, pre-operative MV, extracardiac anomalies, procedure complexity, and bypass time. The model was well-calibrated to predict mean duration of POMV for groups of patients. Table 1 displays the range and median of hospital rates on each of the four metrics, demonstrating variation across the group. The average ranks across these POMV duration metrics suggested two positive outlying hospitals (average rank across all 4 metrics = 1.75) and five hospitals with consistently lower performance (average 8.75-11.25). Conclusions: We developed novel casemix-adjusted metrics of hospital performance to limit duration of POMV following pediatric cardiac surgery, and identified wide variation in relative performance across centers. These metrics may suggest opportunities for improvement when evaluated in context with other perioperative quality measures.