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J Thorac Cardiovasc Surg 2002;123:6-7
© 2002 The American Association for Thoracic Surgery

Editorials

Congenital heart disease outcome analysis: Methodology and rationale

From the Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Chicago, Ill, and Cardiac-Surgical Associates, All Children's Hospital, University of South Florida, St Petersburg, Fla.

Received for publication July 11, 2001. Accepted for publication July 20, 2001. Address for reprints: Constantine Mavroudis, MD, Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, 2300 Children's Place, m/c 22, Chicago, IL 60614-3394 (E-mail: cmavroudis@childrensmemorial.org).

See related article on page 110.

Jenkins and associates ¹ have presented an article describing center-specific mortality differences during the year 1996 based on hospital discharge data from 6 states in which more than 100 operations were performed for congenital heart disease (age < 18 years). They used a consensus-based risk-adjusted scheme, congenital heart surgery-1 (RACHS-1), to stratify procedures for congenital heart disease (procedure driven) in 6 groups (1-6, with 1 indicating easy and 6, difficult).

Jenkins and colleagues ^1-3 are to be congratulated for another significant contribution to the field of outcome analysis in pediatric cardiac surgery. Several previous articles have concluded that both annual surgeon volume and annual hospital volume are significantly (inversely) related to mortality rate. ^2,4-9 However, this conclusion is not universal. ¹⁰ Other studies conclude that there are no data to conclusively indicate that outcomes of cardiac operations are related to a specific minimum number of cases performed annually by a cardiac surgeon ¹¹ or center. ¹⁰ Furthermore, the case mix of a surgeon or program must be carefully considered when evaluating outcomes. ¹² Data validity and accuracy represent additional potentially confounding variables—it has been demonstrated that patients not included in medical audits have a worse . . . [Full Text of this Article]

Related Article

Consensus-based method for risk adjustment for surgery for congenital heart disease

Kathy J. Jenkins, Kimberlee Gauvreau, Jane W. Newburger, Thomas L. Spray, James H. Moller, and Lisa I. Iezzoni
J. Thorac. Cardiovasc. Surg. 2002 123: 110-118. [Abstract] [Full Text] [PDF]

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