Original article
Pediatric cardiac
Comparison of Pediatric Cardiac Surgical Mortality Rates From National Administrative Data to Contemporary Clinical Standards

Presented at the Fifty-fourth Annual Meeting of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 7–10, 2007.
https://doi.org/10.1016/j.athoracsur.2008.10.032Get rights and content

Background

Despite the superior coding and risk adjustment of clinical data, the ready availability, national scope, and perceived unbiased nature of administrative data make it the choice of governmental agencies and insurance companies for evaluating quality and outcomes. We calculated pediatric cardiac surgery mortality rates from administrative data and compared them with widely quoted standards from clinical databases.

Methods

Pediatric cardiac surgical operations were retrospectively identified by ICD-9-CM diagnosis and procedure codes from the Nationwide Inpatient Sample (NIS) 1988–2005 and the Kids' Inpatient Database (KID) 2003. Cases were grouped into Risk Adjustment for Congenital Heart Surgery, version 1 (RACHS-1) categories. In-hospital mortality rates and 95% confidence intervals were calculated.

Results

A total of 55,164 operations from the NIS and 10,945 operations from the KID were placed into RACHS-1 categories. During the 18-year period, the overall NIS mortality rate for pediatric cardiac surgery decreased from 8.7% (95% confidence interval, 8.0% to 9.3%) to 4.6% (95% confidence interval, 4.3% to 5.0%). Mortality rates by RACHS-1 category decreased significantly as well. The KID and NIS mortality rates from comparable years were similar. Overall mortality rates derived from administrative data were higher than those from contemporary national clinical data, The Society of Thoracic Surgeons Congenital Heart Surgery Database, or published data from pediatric cardiac specialty centers. Although category-specific mortality rates were higher in administrative data than in clinical data, a minority of the relationships reached statistical significance.

Conclusions

Despite substantial improvement, mortality rates from administrative data remain higher than those from clinical data. The discrepancy may be attributable to several factors: differences in database design and composition, differences in data collection and reporting structures, and variation in data quality.

Section snippets

Material and Methods

This study was designed as a retrospective cohort analysis. The Oregon Health and Science University Institutional Review Board approved this study. Owing to the nature of the study, patient consent was not required. We obtained data from the Nationwide Inpatient Sample (NIS) and the Kids' Inpatient Database (KID) [3, 4]. Both databases were derived from the Uniform Hospital Discharge Data Set, a uniform, minimum dataset that allows investigation of cost and quality of short-term hospital

Results

From 1988 to 2005, 124,087,005 discharges from 3,948 hospitals were recorded in the NIS. Of these discharges, 55,164 were patients who underwent a congenital cardiac procedure coded in RACHS-1. These operations occurred at 307 hospitals.

During the 18-year study period, the case mix of NIS hospitals performing pediatric cardiac surgery remained similar with the notable exception of category 5 and 6 (Table 1). The percentage of category 5 and 6 cases in the NIS increased steadily from 0.51% to

Comment

In this analysis of 18 years of national administrative data, we found that pediatric cardiac surgical mortality rates have decreased substantially. However, compared with contemporary clinical databases, overall mortality rates in administrative data were higher. The discrepancy may be attributable to several factors: differences in database design and composition, differences in data collection and reporting structures, and variation in data quality. This comparison is timely as governmental

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