Cross-Volume Effect Between Pediatric and Adult Congenital Cardiac Operations in the United States.

Background: Whereas the association between surgical volume and outcomes has been well established, the potential impact of specialized pediatric centers on outcomes of cardiac operations for adults with congenital heart disease has not been elucidated.
Methods: The 2010-2017 Nationwide Readmissions Database was queried to identify all adults with congenital heart disease. High-volume centers were designated the highest tertile of operative case volume annually for both pediatric and adult cardiac operations. Multivariable regression models adjusting for demographic and clinical characteristics were used to evaluate adjusted odds ratios for select outcomes.
Results: Of an estimated 52 357 hospitalizations meeting inclusion criteria, 6074 (11.7%) received an operation at a pediatric high-volume center (pHVC) and 45 652 (87.2%) at an adult high-volume center (aHVC). Compared with an aHVC, patients at a pHVC were on average younger, had a similar Elixhauser Comorbidity Index, and underwent higher risk operations. They more commonly carried private insurance and were categorized within the top income quartile. On multivariable analysis, operations at a pHVC were associated with reduced odds of perioperative complications (adjusted odds ratio [AOR], 0.85; 95% CI, 0.72-0.99), nonhome discharge (AOR, 0.64; 95% CI, 0.55-0.73), and 90-day emergent readmissions (AOR, 0.73; 95% CI, 0.60-0.89) but similar risk of death (AOR, 0.74; 95% CI, 0.43-1.28).
Conclusions: Compared with high-volume hospitals for adult cardiac operations, congenital heart disease operations at high-volume pediatric cardiac centers were associated with reduced odds of complications, nonhome discharges, and urgent readmissions. Our findings may better inform appropriate referral of this cohort of complex patients and regionalization of their care.
(Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)