title: Surgical volume-to-outcome relationship and monitoring of technical performance in pediatric cardiac surgery.
abstract: A significant inverse relationship of surgical institutional and surgeon volumes to outcome has been demonstrated in many high-stakes surgical specialties. By and large, the same results were found in pediatric cardiac surgery, for which a more thorough analysis has shown that this relationship depends on case complexity and type of surgical procedures. Lower-volume programs tend to underperform larger-volume programs as case complexity increases. High-volume pediatric cardiac surgeons also tend to have better results than low-volume surgeons, especially at the more complex end of the surgery spectrum (e.g., the Norwood procedure). Nevertheless, this trend for lower mortality rates at larger centers is not universal. All larger programs do not perform better than all smaller programs. Moreover, surgical volume seems to account for only a small proportion of the overall between-center variation in outcome. Intraoperative technical performance is one of the most important parts, if not the most important part, of the therapeutic process and a critical component of postoperative outcome. Thus, the use of center-specific, risk-adjusted outcome as a tool for quality assessment together with monitoring of technical performance using a specific score may be more reliable than relying on volume alone. However, the relationship between surgical volume and outcome in pediatric cardiac surgery is strong enough that it ought to support adapted and well-balanced health care strategies that take advantage of the positive influence that higher center and surgeon volumes have on outcome.
authors.affiliation: Pediatric Cardiac Surgery, Columbia University Medical Center, Morgan Stanley Children's Hospital of New York-Presbyterian, 3959 Broadway, New York, NY, 10032, USA, dk2757@cumc.columbia.edu.
authors.forename: David
authors.initials: D
authors.lastname: Kalfa
authors.forename: Paul
authors.initials: P
authors.lastname: Chai
authors.forename: Emile
authors.initials: E
authors.lastname: Bacha
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D016507:Cardiology Service, Hospital / Q000592:standards / Q000706:statistics & numerical data; D002318:Cardiovascular Diseases / Q000401:mortality / Q000601:surgery; D002648:Child; D017052:Hospital Mortality; D006776:Hospitals, Pediatric / Q000145:classification*; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods / Q000592:standards; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D020379:Risk Adjustment; D012307:Risk Factors; D013503:Surgery Department, Hospital / Q000592:standards / Q000706:statistics & numerical data; D016526:Workload / Q000706:statistics & numerical data*