Putting the Pediatric Cardiac Care Consortium in Context
2012; Lippincott Williams & Wilkins; Volume: 5; Issue: 4 Linguagem: Inglês
10.1161/circoutcomes.111.964841
ISSN1941-7705
AutoresJeffrey M. Vinocur, James H. Moller, Lazaros Kochilas,
Tópico(s)Cardiac Arrest and Resuscitation
ResumoHomeCirculation: Cardiovascular Quality and OutcomesVol. 5, No. 4Putting the Pediatric Cardiac Care Consortium in Context Free AccessBrief ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessBrief ReportPDF/EPUBPutting the Pediatric Cardiac Care Consortium in ContextEvaluation of Scope and Case Mix Compared With Other Reported Surgical Datasets Jeffrey M. Vinocur, MD, James H. Moller, MD and Lazaros K. Kochilas, MD Jeffrey M. VinocurJeffrey M. Vinocur , James H. MollerJames H. Moller and Lazaros K. KochilasLazaros K. Kochilas Originally published1 Jul 2012https://doi.org/10.1161/CIRCOUTCOMES.111.964841Circulation: Cardiovascular Quality and Outcomes. 2012;5:577–579IntroductionCollaborative multi-institutional clinical registries are critical in pediatric cardiology, with its diverse diagnoses and procedures and relatively low event rates.1,2 Founded in 1982 to support quality improvement,3 the Pediatric Cardiac Care Consortium (PCCC) contains clinical information on over 137 000 patients (through 2007). Centers participate voluntarily and membership has varied over time; of the 57 PCCC centers, 35 have contributed at least 10 years of data.Analyses of PCCC data have contributed to an understanding of cardiac surgical outcomes in children (see online-only Data Supplement Table I).4 Centers of the size range represented in the PCCC (< 500 operations/year) may vary systematically in their case mix relative to larger centers. To provide context for outcomes research reports from the PCCC, we analyzed (1) how the case mix at PCCC centers compares with that in published datasets, and (2) what fraction of the national volume the PCCC captures.Table. Frequency of Selected DiagnosesTetralogyTranspositionTruncusUS births/y1719661252301 2004–2006US infant operations/y National estimate (KID*) 20061501962249 In PCCC centers 200424618858 200523519839 200629321054KID indicates Kids' Inpatient Database; PCCC, Pediatric Cardiac Care Consortium.*Kids' Inpatient Database queried via the HCUPnet ICD-9-CM "all-listed procedure" tool (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality).Comparison of Case MixThe PCCC prospectively collects detailed clinical data on cardiac operations (except isolated ductal ligation for prematurity). The University of Minnesota Institutional Review Board has approved research use of this de-identified database without informed consent.The PCCC classifies operations into 6 categories based on expected early mortality rates using the Risk Adjusted Classification for Congenital Heart Surgery, version 1 (RACHS-1), a validated and widely used system.5,6 We searched the literature for datasets that use RACHS-1 to classify unselected pediatric cardiac operations from North American centers. Excluding some overlapping publications, we identified 1 single-center dataset (Children's Hospital Boston),7 3 multicenter administrative databases (Kids' Inpatient Database,8,9 Pediatric Health Information System,10 and Nationwide Inpatient Sample),11,12 and 2 multicenter clinical databases (Congenital Heart Surgeons' Society12 and Society of Thoracic Surgeons),13 plus the PCCC. We abstracted relevant data (by volume category if available) into Excel (Microsoft).Comparing the distribution of risk categories in each reference cohort and corresponding PCCC subset (Figure; see online-only Data Supplement Table II), the case mixes appear fairly comparable, with only subtle variations.Download figureDownload PowerPointFigure. Case mix (distribution by risk category, x-axis) from each reference dataset ("ref", solid colors) and corresponding Pediatric Cardiac Care Consortium subset (speckled colors). Risk categories 5 and 6 are dark and light orange, respectively, or combined as light orange when separate data were unavailable (see online-only Data Supplement Table II). Datasets (y-axis) are: CHB, Children's Hospital Boston7; KID, Kids' Inpatient Database8,9; NIS, Nationwide Inpatient Sample11,12; CHSS, Congenital Heart Surgeons' Society12; PHIS, Pediatric Health Information System10; STS, Society of Thoracic Surgeons.13 *The KID includes noncontiguous years: 2000, 2003, and 2006.Estimation of Fraction of the Overall PopulationLacking definitive statistics, we estimated from available data the proportion of pediatric cardiac surgeries in the United States (US) covered by the PCCC. In 2003, 122 US centers performed about 25 000 pediatric cardiac operations by 1 report (other estimates include 18 000—33 000 and 19 000 cases/year15,16).14 By comparison, for 2003 the PCCC contains 5323 operations from 34 US centers (ie, 15% to 30% of the estimated national total). For selected infant operations, estimated US PCCC coverage is 10% to 20% by comparison with 2004 to 2006 US birth defect data,17 and 15% to 30% by comparison with the 2006 Kids' Inpatient Database (Table).The overall distribution of volume by center is unknown, but the US mean may be around 200 cases/year.14 The median is likely lower (due to skewed statistical distribution), so a substantial majority of pediatric cardiac centers in the US falls in the size range of PCCC participants (< 500 cases/year).DiscussionComparing case mix at pediatric cardiac surgical centers, the distributions of surgical risk categories are fairly comparable across the largest available clinical and administrative datasets, even when comparing the "average" type of centers represented in the PCCC with a very large international referral center.7It is important to understand the outcomes of pediatric cardiac centers performing fewer than 500 cases/year because a significant fraction of such operations are, and will continue to be, undertaken in such "average" centers.18–20DisclosuresNone.FootnotesThe online-only Data Supplement is available at http://circoutcomes.ahajournals.org/lookup/suppl/doi:10.1161/CIRCOUTCOMES.111.964841/-/DC1.Correspondence to Lazaros K. Kochilas, MD, Department of Pediatrics, Division of Pediatric Cardiology, University of Minnesota Amplatz Children's Hospital, East Building 5th Floor, 2450 Riverside Avenue, Minneapolis, MN 55454, E-mail [email protected].References1. Jacobs ML, Jacobs JP, Franklin RC, Mavroudis C, Lacour-Gayet F, Tchervenkov CI, Walters H, Bacha EA, Clarke DR, William Gaynor J, Spray TL, Stellin G, Ebels T, Maruszewski B, Tobota Z, Kurosawa H, Elliott M. Databases for assessing the outcomes of the treatment of patients with congenital and paediatric cardiac disease–the perspective of cardiac surgery.Cardiol Young. 2008; 18Suppl 2:101–115.CrossrefMedlineGoogle Scholar2. Jacobs JP, Jacobs ML, Mavroudis C, Backer CL, Lacour-Gayet FG, Tchervenkov CI, Franklin RC, Beland MJ, Jenkins KJ, Walters H, Bacha EA, Maruszewski B, Kurosawa H, Clarke DR, Gaynor JW, Spray TL, Stellin G, Ebels T, Krogmann ON, Aiello VD, Colan SD, Weinberg P, Giroud JM, Everett A, Wernovsky G, Elliott MJ, Edwards FH. 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The complex relationship between pediatric cardiac surgical case volumes and mortality rates in a national clinical database.J Thorac Cardiovasc Surg. 2009; 137:1133–1140.CrossrefMedlineGoogle Scholar14. McDonald K, Romano P, Davies S, Haberland C, Geppert J, Ku A, Choudhry K. Measures of pediatric health care quality based on hospital administrative data: the pediatric quality indicators.2006. http://www.qualityindicators.ahrq.gov/Downloads/Software/SAS/V31/pdi_measures_v31.pdf.Google Scholar15. Jacobs ML, Mavroudis C, Jacobs JP, Tchervenkov CI, Pelletier GJ. Report of the 2005 STS congenital heart surgery practice and manpower survey.Ann Thorac Surg. 2006; 82:1152–1189, discussion 1158–1159.CrossrefMedlineGoogle Scholar16. Chang RK, Klitzner TS. Resources, use, and regionalization of pediatric cardiac services.Curr Opin Cardiol. 2003; 18:98–101.CrossrefMedlineGoogle Scholar17. 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Moller J (2015) Using Data to Improve Quality: the Pediatric Cardiac Care Consortium, Congenital Heart Disease, 10.1111/chd.12297, 11:1, (19-25), Online publication date: 1-Jan-2016. Kochilas L, Vinocur J and Menk J (2014) Age‐Dependent Sex Effects on Outcomes After Pediatric Cardiac Surgery, Journal of the American Heart Association, 3:1, Online publication date: 27-Jan-2014. Aldoss O, Arain N, Vinocur J, Menk J, Ameduri R, Bryant R, Kochilas L and Gruenstein D (2013) Frequency of Superior Vena Cava Obstruction in Pediatric Heart Transplant Recipients and Its Relation to Previous Superior Cavopulmonary Anastomosis, The American Journal of Cardiology, 10.1016/j.amjcard.2013.03.029, 112:2, (286-291), Online publication date: 1-Jul-2013. Vinocur J, Menk J, Connett J, Moller J and Kochilas L (2013) Surgical Volume and Center Effects on Early Mortality After Pediatric Cardiac Surgery: 25-Year North American Experience From a Multi-institutional Registry, Pediatric Cardiology, 10.1007/s00246-013-0633-4, 34:5, (1226-1236), Online publication date: 1-Jun-2013. July 2012Vol 5, Issue 4 Advertisement Article InformationMetrics © 2012 American Heart Association, Inc.https://doi.org/10.1161/CIRCOUTCOMES.111.964841PMID: 22811500 Originally publishedJuly 1, 2012 PDF download Advertisement SubjectsCongenital Heart DiseaseEthics and Policy
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