Hostname: page-component-669899f699-tzmfd Total loading time: 0 Render date: 2025-05-05T23:29:37.275Z Has data issue: false hasContentIssue false
  • English
  • Français

Hospital variation in post-operative cardiac extracorporeal membrane oxygenation use and relationship to post-operative mortality

Published online by Cambridge University Press:  04 October 2024

Marissa A. Brunetti Open the ORCID record for Marissa A. Brunetti [Opens in a new window] ,
J. William Gaynor Open the ORCID record for J. William Gaynor [Opens in a new window] ,
Wenying Zhang ,
Mousumi Banerjee ,
Yuliya A. Domnina  and
Michael Gaies
Marissa A. Brunetti*
Affiliation:
Department of Anesthesiology & Critical Care Medicine, Children’s Hospital of Philadelphia & Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
J. William Gaynor
Affiliation:
Department of Surgery, The Cardiac Center, The Children’s Hospital of Philadelphia & Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
Wenying Zhang
Affiliation:
Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI, USA
Mousumi Banerjee
Affiliation:
Department of Biostatistics, School of Public Health & Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
Yuliya A. Domnina
Affiliation:
Division of Cardiac Critical Care Medicine, George Washington University School of Medicine and Children’s National Hospital, Washington, DC, USA
Michael Gaies
Affiliation:
Department of Pediatrics, Cincinnati Children’s Hospital Medical Center Heart Institute, University of Cincinnati College of Medicine, Cincinnati, OH, USA
*
Corresponding author: Marissa A. Brunetti; Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

It is unclear how extracorporeal membrane oxygenation use varies across paediatric cardiac surgical programmes and how it relates to post-operative mortality. We aimed to determine hospital-level variation in post-operative extracorporeal membrane oxygenation use and its association with case-mix adjusted mortality.

Methods:

Retrospective analysis of 37 hospitals contributing to the Pediatric Cardiac Critical Care Consortium clinical registry from 1 August 2014 to 31 December 2019. Hospitalisations including cardiothoracic surgery and post-operative admission to paediatric cardiac ICUs were included. Two-level multivariable logistic regression with hospital random effect was used to determine case-mix adjusted post-operative extracorporeal membrane oxygenation use rates and in-hospital mortality. Hospitals were grouped into extracorporeal membrane oxygenation use tertiles, and mortality was compared across tertiles.

Results:

There were 43,640 eligible surgical hospitalisations; 1397 (3.2%) included at least one post-operative extracorporeal membrane oxygenation run. Case-mix adjusted extracorporeal membrane oxygenation rates varied more than sevenfold (0.9–6.9%) across hospitals, and adjusted mortality varied 10-fold (0–5.5%). Extracorporeal membrane oxygenation rates were 2.0%, 3.5%, and 5.2%, respectively, for low, middle, and high extracorporeal membrane oxygenation use tertiles (P < 0.0001), and mortality rates were 1.9%, 3.0%, and 3.1% (p < 0.0001), respectively. High extracorporeal membrane oxygenation use hospitals were more likely to initiate extracorporeal membrane oxygenation support intraoperatively (1.6% vs. 0.6% low and 1.1% middle, p < 0.0001). Extracorporeal membrane oxygenation indications were similar across hospital tertiles. When extracorporeal cardiopulmonary resuscitation was excluded, variation in extracorporeal membrane oxygenation use rates persisted (1.5%, 2.6%, 3.8%, p < 0.001).

Conclusions:

There is hospital variation in adjusted post-operative extracorporeal membrane oxygenation use after paediatric cardiac surgery and a significant association with adjusted post-operative mortality. These findings suggest that post-operative extracorporeal membrane oxygenation use could be a complementary quality metric to mortality to assess performance of cardiac surgical programmes.

Keywords

extracorporeal membrane oxygenationheart diseaseCHDscardiac surgical procedureperioperative careICUs
Type
Original Article
Information
Cardiology in the Young , Volume 34 , Issue 12 , December 2024 , pp. 2543 - 2550
Check for updates
Copyright
© The Author(s), 2024. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Bratton, SL, Chan, T, Barrett, CS, Wilkes, J, Ibsen, LM, Thiagarajan, RR. Metrics to assess extracorporeal membrane oxygenation utilization in pediatric cardiac surgery programs. Pediatr Crit Care Med. 2017; 18: 779–786.CrossRefGoogle ScholarPubMed
Mascio, CE, Austin, EH, Jacobs, JP et al. Perioperative mechanical circulatory support in children: an analysis of the society of thoracic surgeons congenital heart surgery database. JTCVS. 2014; 147: 658–665.Google Scholar
Gaies, M, Cooper, DS, Tabbutt, S et al. Collaborative quality improvement in the cardiac intensive care unit: development of the paediatric cardiac critical care consortium (PC4). Cardiol Young 2015; 25: 951–957.CrossRefGoogle ScholarPubMed
Pediatric Cardiac Critical Care Consortium. Data definitions manual. (n.d.) https://pc4.arbormetrix.com/Registry/html/datacollection.html?menuId=5183.Google Scholar
Schuette, J, Zaccagni, H, Donohue, J et al. Assessing data accuracy in a large multi-institutional quality improvement registry: an update from the Pediatric Cardiac Critical Care Consortium (PC4). Cardiol Young 2022; 32: 1742–1747.CrossRefGoogle Scholar
Jacobs, JP, Jacobs, ML, Maruszewski, B et al. Initial application in the EACTS and STS congenital heart surgery databases of an empirically derived methodology of complexity adjustment to evaluate surgical case mix and results. Eur J Cardiothoracic Surg 2012; 42: 775–779.CrossRefGoogle ScholarPubMed
Brunetti, MA, Gaynor, JW, Retzloff, LB et al. Characteristics, risk factors, and outcomes of extracorporeal membrane oxygenation use in pediatric cardiac ICUs: a report from the pediatric cardiac critical care consortium registry. Pediatr Crit Care Med 2018; 19: 544–552.CrossRefGoogle ScholarPubMed
Tabbutt, S, Schuette, J, Zhang, W et al. A novel model demonstrates variation in risk-adjusted mortality across pediatric cardiac ICUs after surgery. Pediatr Crit Care Med 2019; 20: 136–142.CrossRefGoogle ScholarPubMed
Jacobs, JP, O’Brien, SM, Pasquali, SK et al. The society of thoracic surgeons congenital heart surgery database mortality risk model: part 2-clinical application. Ann Thorac Surg 2015; 100: 1063–1070.CrossRefGoogle Scholar
Pasquali, SK, He, X, Jacobs, JP, Jacobs, ML, O’Brien, SM, Gaynor, JW. Evaluation of failure to rescue as a quality metric in pediatric heart surgery: an analysis of the STS Congenital Heart Surgery Database. Ann Thorac Surg. 2012; 94: 573–580.CrossRefGoogle ScholarPubMed
Sheetz, KH, Waits, SA, Krell, RW, Campbell, DA, Englesbe, MJ, Ghaferi, AA. Improving mortality following emergency surgery in older patients requires focus on complication rescue. Ann Surg. 2013; 258: 614–618.CrossRefGoogle ScholarPubMed
Sheetz, KH, Krell, RW, Englesbe, MJ, Birkmeyer, JD, Campbell, DA, Ghaferi, AA. The importance of the first complication: understanding failure to rescue after emergent surgery in the elderly. J Am Coll Surg. 2014; 219: 365–370.CrossRefGoogle ScholarPubMed
Pasquali, SK, He, X, Jacobs, JP et al. Measuring hospital performance in congenital heart surgery: administrative versus clinical registry data. Ann Thorac Surg 2015; 99: 932–938.CrossRefGoogle ScholarPubMed
Pasquali, SK, Peterson, ED, Jacobs, JP et al. Differential case ascertainment in clinical registry versus administrative data and impact on outcomes assessment for pediatric cardiac operations. Ann Thorac Surg 2013; 95: 197–203.CrossRefGoogle ScholarPubMed
Gaies, M, Pasquali, SK, Banerjee, M et al. Improvement in pediatric cardiac surgical outcomes through interhospital collaboration. J Am Coll Cardiol 2019; 74: 2786–2795.CrossRefGoogle ScholarPubMed
Supplementary material: File

Brunetti et al. supplementary material

Brunetti et al. supplementary material
Download Brunetti et al. supplementary material(File)
File 159.6 KB