Quality assurance of paediatric cardiac surgery: a prospective 6-year analysis.
OBJECTIVE
To audit effective quality assurance methods to monitor outcomes following paediatric cardiac surgery at a single institution.


METHODS
All patients undergoing cardiac surgery from January 1996 to December 2001 were enrolled prospectively. Patients were stratified by complexity of surgical procedure into four groups, with Category 4 being the most complex procedure. Outcome measures included death, length of admission and morbidity from complications.


RESULTS
A total of 1815 patients underwent 1973 surgical procedures. Of these, 1447 (73.3%) were cardiopulmonary bypass procedures, and 543 (27.5%) were more complex (Category 3 and 4) procedures. Median patient age was 3.5 years (range, 1 day-20 years) and patient weight 15.0 kg (range, 900 g to 90 kg). Sixty-six patients (3.6%) died during the study period. Of the procedures in 1996, 22.7% were classified as complex compared with 29.2% of procedures in 2001. The annual surgical mortality ranged from 1.9-4.7% (P = 0.20), and when mortality was adjusted for complexity of surgery, there was no significant yearly variation in the mortality rate (P = 0.57). Analysis of individual surgeon's results showed no significant difference in the mortality rate by complexity of surgery performed (P = 0.90). Mean ventilation times did not change significantly over time (P = 0.79). The yearly incidence of significant neurological complications ranged from 0.6% to 4.5% and the incidence of arrhythmias from 4.2% to 8.0%. No difference was detected between the years.


CONCLUSIONS
Stratifying complexity of surgery proved valuable in monitoring surgical outcomes and detecting differences in performance over time as large subgroups were created for analysis.
The Queensland Centre for Congenital Heart Disease, The Prince Charles Hospital, Brisbane, Queensland, Australia. robert_justo@health.qld.gov.au
R N
RN
Justo
E F
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Janes
P H
PH
Sargent
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H
Jalali
P G
PG
Pohlner
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011183:Postoperative Complications / Q000401:mortality; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D015996:Survival Rate; D013903:Thoracic Surgery / Q000145:classification / Q000592:standards / Q000706:statistics & numerical data*; D016896:Treatment Outcome