title: Quality metrics in cardiac catheterization for congenital heart disease: utility of 30-day mortality.
abstract: OBJECTIVE
  To characterize the frequency and attributability of death among patients who died within 30 days of their cardiac catheterization (30-day mortality).
  
  
  BACKGROUND
  30-day postprocedure mortality is commonly used as a quality outcome metric in national cardiac catheterization registries. It is unclear if this parameter is sufficiently specific to meaningfully capture mortality attributable to cardiac catheterization in patients with congenital heart disease (CHD).
  
  
  METHODS
  Multicenter cohort study with 3 participating centers. Records were retrospectively reviewed for patients who died within 30 days of catheterization (06/2007-06/2012). Attributability of death was assigned to each case.
  
  
  RESULTS
  A total of 14,707 cardiac catheterization procedures were performed during the study period. Death occurred within 30 days in 279/14,707 (1.9%) of cases. Among the patients who died, 53% of cases were emergent or urgent cases. The median age was 4 mos (1 day-45 years). Death was attributable to the catheterization procedure in 29/279 (10%) of cases. Death was attributable to cardiac surgery in 14%, precatheterization clinical status in 34%, postcatheterization clinical status in 22%, and noncardiac comorbidity in 19%. In 1%, death attributability could not be established.
  
  
  CONCLUSIONS
  While valuable in adult settings, 30-day mortality is inadequate as a quality metric among patients with CHD undergoing cardiac catheterization. To derive the optimal benefit from catheterization registry data, more robust methodologies to capture procedure-related mortality are needed. © 2014 Wiley Periodicals, Inc.
authors.affiliation: Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Carl H
authors.initials: CH
authors.lastname: Backes
authors.forename: Lisa
authors.initials: L
authors.lastname: Bergersen
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Rome
authors.forename: Sarosh P
authors.initials: SP
authors.lastname: Batlivala
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Glatz
authors.forename: Bugsu
authors.initials: B
authors.lastname: Ovunc
authors.forename: Sthuthi
authors.initials: S
authors.lastname: David
authors.forename: Brian K
authors.initials: BK
authors.lastname: Rivera
authors.forename: Urbee
authors.initials: U
authors.lastname: Haque
authors.forename: Kevin
authors.initials: K
authors.lastname: Kollins
authors.forename: Han
authors.initials: H
authors.lastname: Yin
authors.forename: Ralf J
authors.initials: RJ
authors.lastname: Holzer
mesh_terms: D000293:Adolescent; D000328:Adult; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality* / Q000592:standards; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D019984:Quality Indicators, Health Care / Q000592:standards; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: CATH; PEDS; complications; pediatric interventions; quality