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12. Improvement in Pediatric Cardiac Surgical Outcomes Through Interhospital Collaboration

Author

Gaies, Michael, Pasquali, Sara K, Banerjee, Mousumi, Dimick, Justin B, Birkmeyer, John D, Zhang, Wenying, Alten, Jeffrey A, Chanani, Nikhil, Cooper, David S, Costello, John M, Gaynor, J William, Ghanayem, Nancy, Jacobs, Jeffrey P, Mayer, John E, Ohye, Richard G, Scheurer, Mark A, Schwartz, Steven M, Tabbutt, Sarah, and Charpie, John R

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Heart Disease, Patient Safety, Cardiovascular, Clinical Trials and Supportive Activities, Pediatric, Evaluation of treatments and therapeutic interventions, 6.4 Surgery, Good Health and Well Being, Cardiac Surgical Procedures, Child, Preschool, Cooperative Behavior, Critical Care, Female, Heart Defects, Congenital, Hospital Mortality, Humans, Infant, Infant, Newborn, Intensive Care Units, Male, Morbidity, Postoperative Complications, Quality Improvement, Registries, United States, cardiac surgery, collaborative learning, congenital, outcomes, pediatric, quality, Cardiorespiratory Medicine and Haematology, Public Health and Health Services, Cardiovascular System & Hematology, Cardiovascular medicine and haematology
Abstract

BackgroundPatients 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.ObjectivesThe purpose of this study was to determine whether outcomes improved over time within PC4.MethodsThe 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.ResultsDuring 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

Published
2019

17. Defining Quality in Surgery

Author

Howard, Ryan, Dimick, Justin B., Romanelli, John R., editor, Dort, Jonathan M., editor, Kowalski, Rebecca B., editor, and Sinha, Prashant, editor

Published
2022
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44. Duration of Postoperative Mechanical Ventilation as a Quality Metric for Pediatric Cardiac Surgical Programs

Author

Gaies, Michael, Werho, David K, Zhang, Wenying, Donohue, Janet E, Tabbutt, Sarah, Ghanayem, Nancy S, Scheurer, Mark A, Costello, John M, Gaynor, J William, Pasquali, Sara K, Dimick, Justin B, Banerjee, Mousumi, and Schwartz, Steven M

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Bioengineering, Pediatric, Cardiovascular, Heart Disease, Patient Safety, Assistive Technology, 7.3 Management and decision making, Management of diseases and conditions, Adolescent, Adult, Benchmarking, Cardiac Surgical Procedures, Child, Child, Preschool, Female, Hospital Mortality, Humans, Infant, Infant, Newborn, Intensive Care Units, Pediatric, Male, Postoperative Care, Postoperative Complications, Quality Assurance, Health Care, Registries, Respiration, Artificial, Risk Factors, Young Adult, Cardiorespiratory Medicine and Haematology, Respiratory System, Cardiovascular medicine and haematology, Clinical sciences
Abstract

BackgroundFew metrics exist to assess quality of care at pediatric cardiac surgical programs, limiting opportunities for benchmarking and quality improvement. Postoperative duration of mechanical ventilation (POMV) may be an important quality metric because of its association with complications and resource utilization. In this study we modelled case-mix-adjusted POMV duration and explored hospital performance across POMV metrics.MethodsThis study used the Pediatric Cardiac Critical Care Consortium clinical registry to analyze 4,739 hospitalizations from 15 hospitals (October 2013 to August 2015). All patients admitted to pediatric cardiac intensive care units after an index cardiac operation were included. We fitted a model to predict duration of POMV accounting for patient characteristics. Robust estimates of SEs were obtained using bootstrap resampling. We created performance metrics based on observed-to-expected (O/E) POMV to compare hospitals.ResultsOverall, 3,108 patients (65.6%) received POMV; the remainder were extubated intraoperatively. Our model was well calibrated across groups; neonatal age had the largest effect on predicted POMV. These comparisons suggested clinically and statistically important variation in POMV duration across centers with a threefold difference observed in O/E ratios (0.6 to 1.7). We identified 1 hospital with better-than-expected and 3 hospitals with worse-than-expected performance (p

Published
2018

49. Sleeve Gastrectomy

Author

Obeid, Nabeel R., Dimick, Justin B., Patti, Marco G., editor, Di Corpo, Marco, editor, and Schlottmann, Francisco, editor

Published
2020
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50. Surgical Coaching

Author

Pradarelli, Jason C., Greenberg, Caprice C., Dimick, Justin B., Cohen, Tara N., editor, Ley, Eric J., editor, and Gewertz, Bruce L., editor

Published
2020
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