title: Surgical Quality Predicts Length of Stay in Patients with Congenital Heart Disease.
abstract: Historically, the primary marker of quality for congenital cardiac surgery has been postoperative mortality. The purpose of this study was to determine whether additional markers (10 surgical metrics) independently predict length of stay (LOS), thereby providing specific targets for quality improvement. Ten metrics (unplanned ECMO, unplanned cardiac catheterization, revision of primary repair, delayed closure, mediastinitis, reexploration for bleeding, complete heart block, vocal cord paralysis, diaphragm paralysis, and change in preoperative diagnosis) were defined in 2008 and subsequently collected from 1024 consecutive index congenital cardiac cases, yielding 990 cases. Four patient characteristics and 22 case characteristics were used for risk adjustment. Univariate and multivariable analyses were used to determine independent associations between each metric and postoperative LOS. Increased LOS was independently associated with revision of the primary repair (p = 0.014), postoperative complete heart block requiring a permanent pacemaker (p = 0.001), diaphragm paralysis requiring plication (p < 0.001), and unplanned postoperative cardiac catheterization (p < 0.001). Compared with patients without each metric, LOS was 1.6 (95 % CI 1.1-2.2, p = 0.014), 1.7 (95 % CI 1.2-2.3, p = 0.001), 1.8 (95 % CI 1.4-2.3, p < 0.001), and 2.0 (95 % CI 1.7-2.4, p < 0.001) times as long, respectively. These effects equated to an additional 4.5-7.8 days in hospital, depending on the metric. The other 6 metrics were not independently associated with increased LOS. The quality of surgery during repair of congenital heart disease affects outcomes. Reducing the incidence of these 4 specific surgical metrics may significantly decrease LOS in this population.
authors.affiliation: Division of Pediatric Cardiology, Doernbecher Children's Hospital, Oregon Health & Science University (OHSU), 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA. johnseri@ohsu.edu.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Johnson
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, Doernbecher Children's Hospital, Oregon Health & Science University (OHSU), 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
authors.forename: M Mujeeb
authors.initials: MM
authors.lastname: Zubair
authors.affiliation: Division of Pediatric Cardiology, Doernbecher Children's Hospital, Oregon Health & Science University (OHSU), 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
authors.forename: Laurie R
authors.initials: LR
authors.lastname: Armsby
authors.affiliation: Division of Pediatric Cardiology, Doernbecher Children's Hospital, Oregon Health & Science University (OHSU), 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
authors.forename: Grant H
authors.initials: GH
authors.lastname: Burch
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, Doernbecher Children's Hospital, Oregon Health & Science University (OHSU), 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
authors.forename: Milon K
authors.initials: MK
authors.lastname: Good
authors.affiliation: Oregon Institute of Occupational Health Sciences, Oregon Health & Science University (OHSU), 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Lasarev
authors.affiliation: Division of Perinatology, Oregon Health & Science University (OHSU), 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
authors.forename: A Roger
authors.initials: AR
authors.lastname: Hohimer
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, Doernbecher Children's Hospital, Oregon Health & Science University (OHSU), 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
authors.forename: Ashok
authors.initials: A
authors.lastname: Muralidaran
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, Doernbecher Children's Hospital, Oregon Health & Science University (OHSU), 3181 S.W. Sam Jackson Park Rd., Portland, OR, 97239, USA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Langley
mesh_terms: D001145:Arrhythmias, Cardiac / Q000453:epidemiology* / Q000209:etiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007902:Length of Stay; D016014:Linear Models; D008297:Male; D009922:Oregon; D011183:Postoperative Complications / Q000453:epidemiology*; D058996:Quality Improvement; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Congenital heart; Length of stay; Metrics; Quality improvement; Surgery