Variation of ventilation practices with center volume after pediatric heart surgery.

BACKGROUND

This study was designed to evaluate the odds of mechanical ventilation and duration of mechanical ventilation after pediatric cardiac surgery across centers of varying center volume using the Virtual PICU Systems database.

HYPOTHESIS

Children receiving cardiac surgery at high-volume centers will be associated with lower odds of mechanical ventilation and shorter duration of mechanical ventilation, compared with low-volume centers.

METHODS

Patients age <18 years undergoing operations (with or without cardiopulmonary bypass) for congenital heart disease at one of the participating intensive care units in the Virtual PICU Systems database were included (2009-2013). Logistic regression models and Cox proportional hazards models were fitted for the probability of conventional mechanical ventilation and duration of mechanical ventilation, respectively, to investigate the difference in the outcomes between different center volume groups with/without adjustment for other risk factors.

RESULTS

A total of 10 378 patients from 43 centers qualified for inclusion. Of these, 7648 (74%) patients received conventional mechanical ventilation after cardiac surgery. Higher center volume was significantly associated with lower odds of mechanical ventilation after cardiac surgery (odds ratio: 2.68, 95% confidence interval: 2.15-3.35). However, patients receiving mechanical ventilation in these centers were associated with longer duration of mechanical ventilation, compared with lower-volume centers (hazard ratio: 1.26, 95% confidence interval: 1.16-1.37). This association was most prominent in the lower surgical-risk categories.

CONCLUSIONS

Large clinical practice variations were demonstrated for mechanical ventilation following pediatric cardiac surgery among intensive care units of varied center volumes.