title: Impact of varied center volume categories on volume-outcome relationship in children receiving ECMO for heart operations.
abstract: To study the volume-outcome relationship among children receiving extracorporeal membrane oxygenation (ECMO), different studies from different databases use different volume categories. The objective of this study was to evaluate if different center volume categories impact the volume-outcome relationship among children receiving ECMO for heart operations. We performed a post hoc analysis of data from an existing national database, the Pediatric Health Information System. Centers were classified into five different volume categories using different cut-offs and different variables. Mortality rates were compared between the varied volume categories using a mixed effects logistic regression model after adjusting for patient- and center-level risk factors. Data collection included demographic information, baseline characteristics, pre-ECMO risk factors, operation details, patient diagnoses, and center data. In unadjusted analysis, there was a significant relationship between center volume and mortality, with low-and medium-volume centers associated with higher mortality rates compared to high-volume centers in all volume categories, except the hierarchical clustering volume category. In contrast, there was no significant association between center-volume and mortality among all volume categories in adjusted analysis. We concluded that high-volume centers were not associated with improved outcomes for the majority of the categorization schemes despite using different cut-offs and different variables for volume categorization.
authors.affiliation: Biostatistics Section, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
authors.forename: Mallikarjuna
authors.initials: M
authors.lastname: Rettiganti
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Seib
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Robertson
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilcox
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, 1 Children's Way, Slot 512-3, Little Rock, AR, USA. pgupta2@uams.edu.
authors.forename: Punkaj
authors.initials: P
authors.lastname: Gupta
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D015199:Extracorporeal Membrane Oxygenation / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Cardiac surgery; Center volume; Children; Extracorporeal membrane oxygenation; Mortality