Five-year outcomes after regionalizing pediatric cardiac surgery centers

Abstract

Infant mortality after cardiac surgery is multifactorial, but can be related to center and surgeon case volume. One method to increase case volume is to consolidate or regionalize pediatric cardiac surgical care. We evaluated in-hospital and 5-year outcomes in three separate pediatric cardiac surgical programs before and after they formed one regional consortium. Infants (<1 year of age) undergoing complete biventricular surgery were divided into two groups: pre-regionalization (when operations were performed at three separate hospitals between, 1991 and 1998) and post-regionalization (when all operations were performed at one regional program at two surgical centers between, 2001 and 2010). Cases during 1999 and 2000 were excluded as the consortium at that time included only two of the three programs. Primary outcomes were hospital mortality, 5-year survival, cardiac re-operation, and number of events (deaths plus re-operations) during the 5-year follow-up for each group. The 671 infants in the pre-regionalization group did not differ significantly from the 782 infants in the post-regionalization group in age at surgery, weight, or sex. Hospital mortality was significantly greater than the state average before regionalization (9.8% vs. 7.1%; 95% CI of difference: 0.008, 0.052, P < 0.001), but significantly lower than the state average after regionalization (1.9% vs. 4.5%; 95% CI of difference 0.013, 0.043, P < 0.001). Regionalization also significantly improved the 5-year survival (90.2% vs 95.2%; P < 0.001) and freedom from re-operation (83.4% vs. 91.1%; P < 0.001). Multivariate analysis showed that regionalization was independently associated with mortality lower event rate (hazard ratio, 0.35; 95% CI, 0.23 to 0.53; P < 0.001). In our experience, regionalizing and consolidating pediatric cardiac surgical care improved both in-hospital and 5-year survival outcomes. Application of this strategy in other regions of the US may be feasible and beneficial.