Improvement in Pediatric Cardiac Surgical Outcomes Through Interhospital Collaboration

• Type of Material: Article
• Authors: Michael Gaies, University of Michigan; Sara K. Pasquali, University of Michigan; Mousumi Banerjee, University of Michigan; Justin B. Dimick, University of Michigan; John D. Birkmeyer, Sound Physicans; Wenying Zhang, University of Michigan; Jeffrey A. Alten, University of Cincinnati; Nikhil Chanani, Emory University; David S. Cooper, University of Cincinnati; John M. Costello, Medical University of South Carolina; J. Wiliam Gaynor, University of Pennsylvania; Nancy Ghanayem, Baylor College of Medicine; Jeffrey P. Jacobs, Society of Thoracic Surgeons; John E. Mayer, Harvard Medical School; Richard G. Ohye, University of Michigan; Mark A. Scheurer, Medical University of South Carolina; Steven M. Schwartz, University of Toronto; Sarah Tabbutt, University of California San Francisco; John R. Charpie, University of Michigan
• Language: English
• Date: 2019-12-03
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: 2019
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jacc.2019.09.046
• Title of Journal or Parent Work: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
• Volume: 74
• Issue: 22
• Start Page: 2786
• End Page: 2795
• Grant/Funding Information: Gaies was supported in part by funding from the National Institutes of Health/National Heart, Lung, and Blood Institute (K08HL116639). This study was supported in part by the National Heart, Lung, and Blood Institute (R01HL12226; PI Pasquali). Pasquali also received support from the Janette Ferrantino Professorship, University of Michigan, Ann Arbor, MI. The PC4 Data Coordinating Center receives funding from the University of Michigan Congenital Heart Center, CHAMPS for Mott, and the Michigan Institute for Clinical & Health Research (NIH/NCATS UL1TR002240), all University of Michigan, Ann Arbor, MI.
• Keywords: MODEL; pediatric; Cardiovascular System & Cardiology; collaborative learning; Life Sciences & Biomedicine; quality; OPERATIONS; CONGENITAL HEART-SURGERY; outcomes; cardiac surgery; congenital; Science & Technology; Cardiac & Cardiovascular Systems; SOCIETY
• Research Categories: Health Sciences, Medicine and Surgery; Biology, General

Abstract

Background: Patients undergoing complex pediatric cardiac surgery remain at considerable risk of mortality and morbidity, and variation in outcomes exists across hospitals. The Pediatric Cardiac Critical Care Consortium (PC4) was formed to improve the quality of care for these patients through transparent data sharing and collaborative learning between participants. Objectives: The purpose of this study was to determine whether outcomes improved over time within PC4. Methods: The study analyzed 19,600 hospitalizations (18 hospitals) in the PC4 clinical registry that included cardiovascular surgery from August 2014 to June 2018. The primary exposure was 2 years of PC4 participation; this provided adequate time for hospitals to accrue data and engage in collaborative learning. Aggregate case mix–adjusted outcomes were compared between the first 2 years of participation (baseline) and all months post-exposure. We also evaluated outcomes from the same era in a cohort of similar, non-PC4 hospitals. Results: During the baseline period, there was no evidence of improvement. We observed significant improvement in the post-exposure period versus baseline for post-operative intensive care unit mortality (2.1% vs. 2.7%; 22% relative reduction [RR]; p = 0.001), in-hospital mortality (2.5% vs. 3.3%; 24% RR; p = 0.001), major complications (10.1% vs. 11.5%; 12% RR; p < 0.001), intensive care unit length of stay (7.3 days vs. 7.7 days; 5% RR; p < 0.001), and duration of ventilation (61.3 h vs. 70.6 h; 13% RR; p = 0.01). Non-PC4 hospitals showed no significant improvement in mortality, complications, or hospital length of stay. Conclusions: This analysis demonstrates improving cardiac surgical outcomes at children's hospitals participating in PC4. This change appears unrelated to secular improvement trends, and likely reflects PC4’s commitment to transparency and collaboration.