Adverse event rates in congenital cardiac catheterization - a multi-center experience.
OBJECTIVE
To describe case mix variation among institutions, and report adverse event rates in congenital cardiac catheterization by case type.


BACKGROUND
Reported adverse event rates for patients with congenital heart disease undergoing cardiac catheterization vary considerably, due to non-comparable standards of data inclusion, and highly variable case mix.


METHODS
The Congenital Cardiac Catheterization Outcomes Project (C3PO) has been capturing case characteristics and adverse events (AE) for all cardiac catheterizations performed at six pediatric institutions. Validity and completeness of data were independently audited.


RESULTS
Between 2/1/07 and 4/30/08, 3855 cases (670 biopsy, 1037 diagnostic, and 2148 interventional) were recorded, median number of cases per site 480 (308 to 1526). General anesthesia was used in 70% of cases (28 to 99%), and 22% of cases (15 to 26%) were non-electively or emergently performed. Three institutions performed a higher proportion of interventions during a case, 72 to 77% compared to 56 to 58%. The median rate of AE reported per institution was 16%, ranging from 5 to 18%. For interventional cases the median rate of AE reported per institution was 19% (7 to 25%) compared to 10% for diagnostic cases (6 to 16%). The incidence of AE was significantly higher for interventional compared to diagnostic cases (20% vs 10%, p<0.001), as was the incidence of higher severity AE (9% vs 5%, p<0.001). Adverse events in biopsy cases were uncommon.


CONCLUSIONS
In this multi-institutional cohort, the incidence of AE is higher among interventional compared to diagnostic cases, and is very low among biopsy cases. Equitable comparisons among institutions will require the development and application of risk adjustment methods.
Bergersen
Lisa
L
Children's Hospital Boston, Boston, MA, USA. Lisa.Bergersen@cardio.chboston.org
Marshall
Audrey
A
Gauvreau
Kimberlee
K
Beekman
Robert
R
Hirsch
Russel
R
Foerster
Susan
S
Balzer
David
D
Vincent
Julie
J
Hellenbrand
William
W
Holzer
Ralf
R
Cheatham
John
J
Moore
John
J
Lock
James
J
Jenkins
Kathy
K
D006328:Cardiac Catheterization / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D006330:Heart Defects, Congenital / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011446:Prospective Studies