Original articlePediatric cardiacComparison of Pediatric Cardiac Surgical Mortality Rates From National Administrative Data to Contemporary Clinical Standards
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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2016, Journal of Surgical ResearchCitation Excerpt :One previous study comparing cardiac surgery mortality in children between the Nationwide Inpatient Sample as an administrative database and two clinical databases has shown that overall mortality rate in the Nationwide Inpatient Sample was higher [21]. This difference has been attributed to difference in data design, collection, and quality [21]. The NBR, like most of other clinical registries, has a voluntary participation, which could result in selection bias.
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2015, Journal of PediatricsCitation Excerpt :Even though racial variation in procedure and mortality reporting has not been examined, Horowitz et al did not find racial variation in accuracy of complication reporting.31 In addition, the application of the RACHS methodology to administrative datasets, when compared with clinical datasets, does not result in biased estimates of overall case mix or in-hospital mortality,30,32 suggesting that these dataset methodologies do not create sampling bias. Secondly, because the KID database is not structured to examine the temporal relationship of complications, it is possible that complications may occur prior to hospital admission.