Pediatric cardiac surgery: the effect of hospital and surgeon volume on in-hospital mortality.
OBJECTIVE
To examine the relationship between annual provider (hospital and surgeon) volume of pediatric cardiac surgery and in-hospital mortality.


METHODS
Population-based retrospective cohort study using a clinical database.


METHODS
The 16 acute care hospitals in New York with certificate of need approval to perform pediatric cardiac surgery.


METHODS
All children undergoing congenital heart surgery in New York from 1992 to 1995.


METHODS
Risk-adjusted mortality rates for various hospital and surgeon volume ranges. Adjustments were made for severity of illness using logistic regression.


RESULTS
A total of 7169 cases were analyzed. After controlling for severity of preprocedural illness using clinical risk factors, hospitals with annual pediatric cardiac surgery volumes of fewer than 100 had significantly higher mortality rates (8.26%) than hospitals with volumes of 100 or more (5.95%), and surgeons with annual volumes of fewer than 75 had significantly higher mortality rates (8.77%) than surgeons with annual volumes of 75 or more (5.90%).


CONCLUSIONS
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.
Hannan
E L
EL
Department of Health Policy, Management, and Behavior, State University of New York, University at Albany, USA.
Racz
M
M
Kavey
R E
RE
Quaegebeur
J M
JM
Williams
R
R
D006348:Cardiac Surgical Procedures / Q000401:mortality* / Q000706:statistics & numerical data; D002309:Cardiology / Q000706:statistics & numerical data; D016507:Cardiology Service, Hospital / Q000706:statistics & numerical data*; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D009518:New York / Q000453:epidemiology; D010372:Pediatrics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016526:Workload / Q000706:statistics & numerical data*