The Congenital Heart Institute of Florida, Saint Petersburg, Florida33701, USA.
Ann Thorac Surg. 2011 Dec;92(6):2184-91; discussion 2191-2. doi: 10.1016/j.athoracsur.2011.06.008.
We evaluated outcomes for common operations in The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSDB) to provide contemporary benchmarks and examine variation between centers.
Patients undergoing surgery from 2005 to 2009 were included. Centers with greater than 10% missing data were excluded. Discharge mortality and postoperative length of stay (PLOS) among patients discharged alive were calculated for 8 benchmark operations of varying complexity. Power for analyzing between-center variation in outcome was determined for each operation. Variation was evaluated using funnel plots and Bayesian hierarchical modeling.
Eighteen thousand three hundred seventy-five index operations at 74 centers were included in the analysis of 8 benchmark operations. Overall discharge mortality was: ventricular septal defect (VSD) repair = 0.6% (range, 0% to 5.1%), tetralogy of Fallot (TOF) repair = 1.1% (range, 0% to 16.7%), complete atrioventricular canal repair (AVC) = 2.2% (range, 0% to 20%), arterial switch operation (ASO) = 2.9% (range, 0% to 50%), ASO + VSD = 7.0% (range, 0% to 100%), Fontan operation = 1.3% (range, 0% to 9.1%), truncus arteriosus repair = 10.9% (0% to 100%), and Norwood procedure = 19.3% (range, 0% to 100%). Funnel plots revealed that the number of centers characterized as outliers were VSD = 0, TOF = 0, AVC = 1, ASO = 3, ASO + VSD = 1, Fontan operation = 0, truncus arteriosus repair = 4, and Norwood procedure = 11. Power calculations showed that statistically meaningful comparisons of mortality rates between centers could be made only for the Norwood procedure, for which the Bayesian-estimated range (95% probability interval) after risk-adjustment was 7.0% (3.7% to 10.3%) to 41.6% (30.6% to 57.2%). Between-center variation in PLOS was analyzed for all operations and was larger for more complex operations.
This analysis documents contemporary benchmarks for common pediatric cardiac surgical operations and the range of outcomes among centers. Variation was most prominent for the more complex operations. These data may aid in quality assessment and quality improvement initiatives.
我们评估了胸外科医师学会先天性心脏病外科学数据库（STS-CHSDB）中常见手术的结果，旨在提供当代基准并检查各中心之间的差异。
纳入 2005 年至 2009 年期间接受手术的患者。排除中心有超过 10%数据缺失的患者。计算 8 种不同复杂程度的基准手术中存活出院患者的出院死亡率和术后住院时间（PLOS）。为每种手术确定了分析中心间结果差异的功效。使用漏斗图和贝叶斯层次模型评估变异。
74 个中心的 18375 例索引手术纳入 8 项基准手术的分析。整体出院死亡率为：室间隔缺损（VSD）修复=0.6%（范围，0%至 5.1%），法洛四联症（TOF）修复=1.1%（范围，0%至 16.7%），完全房室管修复（AVC）=2.2%（范围，0%至 20%），动脉调转术（ASO）=2.9%（范围，0%至 50%），ASO+VSD=7.0%（范围，0%至 100%），Fontan 手术=1.3%（范围，0%至 9.1%），大动脉转位修复术=10.9%（0%至 100%），Norwood 手术=19.3%（范围，0%至 100%）。漏斗图显示，被归类为异常值的中心数量为 VSD=0，TOF=0，AVC=1，ASO=3，ASO+VSD=1，Fontan 手术=0，大动脉转位修复术=4，Norwood 手术=11。功效计算表明，只有在 Norwood 手术中才能对死亡率进行有统计学意义的中心间比较，校正风险后贝叶斯估计的范围（95%概率区间）为 7.0%（3.7%至 10.3%）至 41.6%（30.6%至 57.2%）。对所有手术的术后住院时间（PLOS）进行了中心间变异分析，复杂程度较高的手术变异较大。
本分析记录了常见儿科心脏外科学手术的当代基准以及各中心的结果范围。复杂程度较高的手术差异最为明显。这些数据可能有助于质量评估和质量改进计划。
