title: Variation in outcomes for benchmark operations: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database.
abstract: BACKGROUND
  We evaluated outcomes for common operations in The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSDB) to provide contemporary benchmarks and examine variation between centers.
  
  
  METHODS
  Patients undergoing surgery from 2005 to 2009 were included. Centers with greater than 10% missing data were excluded. Discharge mortality and postoperative length of stay (PLOS) among patients discharged alive were calculated for 8 benchmark operations of varying complexity. Power for analyzing between-center variation in outcome was determined for each operation. Variation was evaluated using funnel plots and Bayesian hierarchical modeling.
  
  
  RESULTS
  Eighteen thousand three hundred seventy-five index operations at 74 centers were included in the analysis of 8 benchmark operations. Overall discharge mortality was: ventricular septal defect (VSD) repair = 0.6% (range, 0% to 5.1%), tetralogy of Fallot (TOF) repair = 1.1% (range, 0% to 16.7%), complete atrioventricular canal repair (AVC) = 2.2% (range, 0% to 20%), arterial switch operation (ASO) = 2.9% (range, 0% to 50%), ASO + VSD = 7.0% (range, 0% to 100%), Fontan operation = 1.3% (range, 0% to 9.1%), truncus arteriosus repair = 10.9% (0% to 100%), and Norwood procedure = 19.3% (range, 0% to 100%). Funnel plots revealed that the number of centers characterized as outliers were VSD = 0, TOF = 0, AVC = 1, ASO = 3, ASO + VSD = 1, Fontan operation = 0, truncus arteriosus repair = 4, and Norwood procedure = 11. Power calculations showed that statistically meaningful comparisons of mortality rates between centers could be made only for the Norwood procedure, for which the Bayesian-estimated range (95% probability interval) after risk-adjustment was 7.0% (3.7% to 10.3%) to 41.6% (30.6% to 57.2%). Between-center variation in PLOS was analyzed for all operations and was larger for more complex operations.
  
  
  CONCLUSIONS
  This analysis documents contemporary benchmarks for common pediatric cardiac surgical operations and the range of outcomes among centers. Variation was most prominent for the more complex operations. These data may aid in quality assessment and quality improvement initiatives.
authors: The Congenital Heart Institute of Florida, Saint Petersburg, Florida33701, USA. jeffjacobs@msn.com
authors: Jeffrey Phillip
authors: JP
authors: Jacobs
authors: Sean M
authors: SM
authors: O'Brien
authors: Sara K
authors: SK
authors: Pasquali
authors: Marshall Lewis
authors: ML
authors: Jacobs
authors: Francois G
authors: FG
authors: Lacour-Gayet
authors: Christo I
authors: CI
authors: Tchervenkov
authors: Erle H
authors: EH
authors: Austin
authors: Christian
authors: C
authors: Pizarro
authors: Kamal K
authors: KK
authors: Pourmoghadam
authors: Frank G
authors: FG
authors: Scholl
authors: Karl F
authors: KF
authors: Welke
authors: Constantine
authors: C
authors: Mavroudis
mesh_terms: D001499:Bayes Theorem; D019985:Benchmarking; D006348:Cardiac Surgical Procedures / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016896:Treatment Outcome