Takeaways:
- A study analyzing nearly 26,000 pediatric cardiac surgery operations across 235 low-, mid-, and high-volume hospitals in the United States challenged the assumption that procedure volume alone determines quality outcomes, including mortality rates.
- The research, led by Christopher E. Mascio, MD, from West Virginia University, utilized the Kids’ Inpatient Database (KID) from 2016 to 2019 to evaluate outcomes for hospitals performing at least one of eight benchmark operations.
- Hospitals were categorized into low-volume (≤103 cases/year), mid-volume (104 to 194 cases/year), and high-volume (>194 cases/year) groups. The study found no statistically significant differences in mortality rates for benchmark operations between low- and mid-volume hospitals compared to high-volume hospitals.
- The risk-adjusted mortality rate across all volume groups was 1.9%, with underperforming and overperforming hospitals identified in each category. Case volume was deemed an unfair quality metric for pediatric cardiac surgery outcomes.
- The study's findings suggest that using case volume as a sole indicator for quality may unfairly stigmatize high-performing, low-volume programs.
A recent study suggested variations in procedure volume may not be the lone indicator of quality outcomes, including mortality rates, within hospitals performing pediatric cardiac surgery.1
The real-world analysis identified performance deficits among nearly 26,000 operations performed across 235 low-, mid-, and high-volume hospitals in the United States, suggesting case volume as a surrogate for quality may lead to unnecessary conclusions.
“This national, real-world, risk-adjusted volume-outcome analysis highlights that volume alone may not be the solitary arbiter to predict the quality of pediatric cardiac surgery outcomes in the United States,” wrote the investigative team, led by Christopher E. Mascio, MD, department of cardiovascular and thoracic surgery, West Virginia University.
Prior research has indicated a positive correlation between procedure volume and outcomes, leading many to believe that higher volume is associated with improved outcomes for pediatric cardiac surgery.2 However, program quality can be due to several factors, with evidence suggesting a complex relationship between annual case numbers and patient outcomes. These complexities may be due to system- or operator-dependent factors or patient-related variables.
For this analysis, Mascio and colleagues assessed the differences in mortality between low-, mid-, and high-volume hospitals in the US that perform pediatric cardiac surgery.1 To do so, the investigators team used the Kids’ Inpatient Database (KID), the largest publicly available all-payer pediatric inpatient care database in the US, which randomly samples 80% of complicated pediatric discharges (<21 years). The team analyzed data from the 2016 to 2019 KID to evaluate outcomes in hospitals performing at least 1 of 8 benchmark operations from the STS.
The analysis excluded hospitals performing only off-bypass coarctation and ventricular septal defect repair. Included hospitals were separated into terciles, according to the annual on-pump case volume: low-volume (≤103 cases/year), mid-volume (104 to 194 cases/year), and high-volume (>194 cases/year).
Multivariable logistic regression models were used to collect the adjusted in-hospital mortality rates for each included hospital. The study included 25,749 operations performed by 235 hospitals for analysis. These included 140 low-volume hospitals, 64 mid-volume hospitals, and 31 high-volume hospitals.
