Pediatric Cardiac Surgery: The Effect of Hospital and Surgeon Volume on In-hospital Mortality

Hannan, Edward L.; Racz, Michael; Kavey, Rae-Ellen W.; Quaegebeur, Jan M.; Williams, Roberta G.

doi:10.1542/peds.101.6.963

Cited by 306 publications

(177 citation statements)

References 8 publications

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“…This is in common with another study with the same characteristics, 19 where no significant difference were observed between the two groups assessed, and also with other work in the area in terms of the age groups most affected. 19,20 The distribution of type of heart disease in the current study was also similar to what is found in the literature, where left-right shunt heart diseases are the most common as the most common CHD. 19,20 Also of note is group 5 (22.8%), complex heart disease, a pattern that is common at referral centers for pediatric heart surgery, as is the case at the study center.…”

Section: Discussionsupporting

confidence: 88%

Efeito terapêutico da música em crianças em pós-operatório de cirurgia cardíaca

Hatem¹,

Lira²,

Mattos³

2006

J. Pediatr. (Rio J.)

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Objective: To investigate, both objectively and subjectively, the effect of music on children in a pediatric cardiac intensive care unit following heart surgery, in conjunction with standard care.Methods: Randomized clinical trial with placebo, assessing 84 children, aged 1 day to 16 years, during the first 24 hours of the postoperative period, given a 30 minute music therapy session with classical music and observed at the start and end of the session, recording heart rate, blood pressure, mean blood pressure, respiratory rate, temperature and oxygen saturation, plus a facial pain score. Statistical significance was set at 5%.Results: Five of the initial 84 patients (5.9%) refused to participate. The most common type of heart disease was acyanotic congenital with left-right shunt (41% of cases: 44.4% of controls). Statistically significant differences were observed between the two groups after the intervention in the subjective facial pain scale and the objective parameters heart rate and respiratory rate (p < 0.001, p = 0.04 and p = 0.02, respectively).Conclusions: A beneficial effect from music was observed with children during the postoperative period of heart surgery, by means of certain vital signs (heart rate and respiratory rate) and in reduced pain (facial pain scale). Nevertheless, there are gaps to be filled in this area, and studies in greater depth are needed.

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Section: Discussionsupporting

confidence: 88%

Efeito terapêutico da música em crianças em pós-operatório de cirurgia cardíaca

Hatem¹,

Lira²,

Mattos³

2006

J. Pediatr. (Rio J.)

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“…Many studies have shown that, in the past two decades, the hospital and surgeon volume are closely associated with better surgical outcome with lower postoperative complications or mortalities, such as paediatric cardiac surgery, 4 repair of abdominal aortic aneurysm, 5 coronary artery bypass graft surgery, 6 ventriculo-peritoneal shunt procedures, 7 total hip replacement surgery, 8 and colon cancer surgery. 9 However, only few studies reported the relationship between provider volume and the incidence of postoperative endophthalmitis.…”

Section: Introductionmentioning

confidence: 99%

Association of hospital and surgeon operation volume with the incidence of postoperative endophthalmitis: Taiwan experience

Fang

Chien²,

et al. 2005

Eye

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Purpose To determine the association between hospital and surgeon volume with the incidence of postoperative endophthalmitis. Methods A prospective cohort study was conducted to analyse the national health insurance claims data of those patients receiving cataract surgery in 2000 in Taiwan. A total of 108 705 patients who received cataract surgery by 1004 surgeons at 494 hospitals were followed to the end of 2002. Stepwise Cox regression was used to analyse the effects of hospital and surgeon volume of cataract surgery on postoperative endophthalmitis after adjustment for patient's age, gender, education, ophthalmic comorbidities, general comorbidities, and surgical factors including operative methods, different types of intraocular lenses, and surgeon's age. Results The 2-year incidence of postoperative endophthalmitis at high-volume hospitals (0.90%) was lower than low-volume hospitals (1.16%). The incidence of postoperative endophthalmitis by highvolume surgeons (0.59%) was lower than those by middle-high-volume (0.73%), middle-lowvolume (0.80%), or low-volume surgeons (1.16%). After controlling for case mix, the risk of postoperative endophthalmitis of the lowvolume hospitals (hazard ratio (HR) ¼ 1.39) was higher than that of the high-volume hospitals. The risk of postoperative endophthalmitis of low-volume surgeons (HR ¼ 1.67) was higher than that of the highvolume surgeons. ConclusionsThe provider volume (hospital and surgeon volume) is associated with the risk of postoperative endophthalmitis. The patients who receive cataract surgery at lowvolume hospitals or by low-volume surgeons have significantly higher risk of postoperative endophthalmitis than at high-volume hospitals or by high-volume surgeons. Provider volume can be considered in further postoperative endophthalmitis study as a risk factor. Eye (2006) 20, 900-907.

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“…40 The relation of in-hospital mortality rates to case volume for congenital heart surgery has been examined in studies using statewide administrative data. [41][42][43][44] All have shown a significant correlation between improvement in severity-adjusted mortality rate and increasing institutional case volume. However, institutional case volume explains only a relatively small fraction of the variability in outcomes among pediatric heart surgery programs, and uncommon outcomes such as mortality are difficult to measure with statistical precision for smaller programs.…”

Section: Quality Of Carementioning

confidence: 99%

Guidelines for Pediatric Cardiovascular Centers

Cardiology¹

2002

Pediatrics

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ABSTRACT. Pediatric cardiovascular centers should aim to provide high-quality therapeutic outcomes for infants and children with congenital and acquired heart diseases. This policy statement describes critical elements and organizational features of centers in which high-quality outcomes have the greatest likelihood of occurring. Center elements include noninvasive diagnostic modalities, cardiac catheterization, cardiovascular surgery, and cardiovascular intensive care. These elements should be organizationally united in centers in which pediatric cardiac physician specialists and specialized pediatric staff work together to achieve and surpass existing quality-of-care benchmarks.

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Pediatric Cardiac Surgery: The Effect of Hospital and Surgeon Volume on In-hospital Mortality

Abstract: Both hospital volume and surgeon volume are significantly associated with in-hospital mortality, and these differences persist for both high-complexity and low-complexity pediatric cardiac procedures.

Cited by 306 publications

References 8 publications

Efeito terapêutico da música em crianças em pós-operatório de cirurgia cardíaca

Efeito terapêutico da música em crianças em pós-operatório de cirurgia cardíaca

Association of hospital and surgeon operation volume with the incidence of postoperative endophthalmitis: Taiwan experience

Guidelines for Pediatric Cardiovascular Centers

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