title: Higher programmatic volume in paediatric heart surgery is associated with better early outcomes.
abstract: OBJECTIVE
  Previous analyses have suggested an association between centre volume and in-hospital mortality, post-operative complications, and mortality in those patients who suffer from a complication. We sought to determine the nature of this association using a multicentre cohort.
  
  
  METHODS
  All the patients, aged 18 years or younger, undergoing heart surgery at centres participating in the European Congenital Heart Surgeons Database (2003-2013) were included. Programmes were grouped as follows: small 350. Multivariable logistic regression was used to identify the differences between groups with the adjusted in-hospital mortality, onset of any and/or major complication, and in-hospital mortality in those patients with any and/or major complication. The outcomes were adjusted for patient specific risk factors and surgical risk factors.
  
  
  RESULTS
  The data set consisted of 119,345 procedures performed in 99 centres. Overall, in-hospital mortality was 4.63%; complications occurred in 23.4% of the patients. In-hospital mortality in patients with complications was 13.82%. Multivariable logistic regression showed that the risk of in-hospital death was higher in low- and medium-volume centres (p<0.001). The rate of the occurrence of any post-operative complication in small, medium, and large programmes was lower compared with very large centres (p<0.001). Low- and medium-volume centres were associated with significantly higher mortality in patients with any complication (p<0.001).
  
  
  CONCLUSIONS
  Our analysis showed that the risk of in-hospital mortality was lower in higher-volume centres. Although the risk of complications is higher in high-volume centres, the mortality associated with complications that occurred in these centres was lower.
authors.affiliation: 1The Children's Memorial Health Institute,Warsaw,Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kansy
authors.affiliation: 2University Medical Center Groningen,Groningen,the Netherlands.
authors.forename: Tjark
authors.initials: T
authors.lastname: Ebels
authors.affiliation: 3Department of Cardiovascular Surgery,German Heart Center Munich at the Technical University Munich,Munich,Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schreiber
authors.affiliation: 4Division of Cardiovascular Surgery,Department of Surgery, Johns Hopkins All Children's Heart Institute,All Children's Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, Orlando, Florida,United States of America.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.affiliation: 1The Children's Memorial Health Institute,Warsaw,Poland.
authors.forename: Zdzislaw
authors.initials: Z
authors.lastname: Tobota
authors.affiliation: 1The Children's Memorial Health Institute,Warsaw,Poland.
authors.forename: Bohdan
authors.initials: B
authors.lastname: Maruszewski
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005060:Europe / Q000453:epidemiology; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D017052:Hospital Mortality; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality
keywords: Congenital heart disease; early results; outcome; paediatric heart disease; patient safety