title: Trends in 30-day mortality rate and case mix for paediatric cardiac surgery in the UK between 2000 and 2010.
abstract: To explore changes over time in the 30-day mortality rate for paediatric cardiac surgery and to understand the role of attendant changes in the case mix.
  
  
  
  Included were: all mandatory submissions to the National Institute of Cardiovascular Outcomes Research (NICOR) relating to UK cardiac surgery in patients aged <16 years. The χ(2) test for trend was used to retrospectively analyse the proportion of surgical episodes ending in 30-day mortality and with various case mix indicators, in 10 consecutive time periods, from 2000 to 2010. Comparisons were made between two 5-year eras of: 30-day mortality, period prevalence and mean age for 30 groups of specific operations.
  
  
  
  30-day mortality for an episode of surgical management.
  
  
  
  Our analysis includes 36 641 surgical episodes with an increase from 2283 episodes in 2000 to 3939 in 2009 (p<0.01). The raw national 30-day mortality rate fell over the period of review from 4.3% (95% CI 3.5% to 5.1%) in 2000 to 2.6% (95% CI 2.2% to 3.0%) in 2009/2010 (p<0.01). The case mix became more complex in terms of the percentage of patients <2.5 kg (p=0.05), with functionally univentricular hearts (p<0.01) and higher risk diagnoses (p<0.01). In the later time era, there was significant improvement in 30-day mortality for arterial switch with ventricular septal defect (VSD) repair, patent ductus arteriosus ligation, Fontan-type operation, tetralogy of Fallot and VSD repair, and the mean age of patients fell for a range of operations performed in infancy.
  
  
  
  The raw 30-day mortality rate for paediatric cardiac surgery fell over a decade despite a rise in the national case mix complexity, and compares well with international benchmarks. Definitive repair is now more likely at a younger age for selected infants with congenital heart defects.
authors.affiliation: Cardiac Unit , Great Ormond Street Hospital for Children , London , UK ; Institute for Cardiovascular Science, University College London, London , UK.
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Brown
authors.affiliation: Clinical Operational Research Unit , University College London , London , UK.
authors.forename: Sonya
authors.initials: S
authors.lastname: Crowe
authors.affiliation: Department of Paediatric Cardiology , Royal Brompton and Harefield NHS Foundation Trust , London , UK.
authors.forename: Rodney
authors.initials: R
authors.lastname: Franklin
authors.affiliation: Cardiac Surgery Department , The Royal Hospital for Sick Children , Glasgow , UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: McLean
authors.affiliation: National Institute for Cardiac Outcomes Research (NICOR), University College London , London , UK.
authors.forename: David
authors.initials: D
authors.lastname: Cunningham
authors.affiliation: Cardiac Surgery Department , Birmingham Children's Hospital , Birmingham , UK.
authors.forename: David
authors.initials: D
authors.lastname: Barron
authors.affiliation: Cardiac Unit , Great Ormond Street Hospital for Children , London , UK ; Institute for Cardiovascular Science, University College London, London , UK.
authors.forename: Victor
authors.initials: V
authors.lastname: Tsang
authors.affiliation: Clinical Operational Research Unit , University College London , London , UK.
authors.forename: Christina
authors.initials: C
authors.lastname: Pagel
authors.affiliation: Clinical Operational Research Unit , University College London , London , UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Utley
keywords: CONGENITAL HEART DISEASE; QUALITY OF CARE AND OUTCOMES