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Original research article
Trends in 30-day mortality rate and case mix for paediatric cardiac surgery in the UK between 2000 and 2010
  1. Katherine L Brown1,2,
  2. Sonya Crowe3,
  3. Rodney Franklin4,
  4. Andrew McLean5,
  5. David Cunningham6,
  6. David Barron7,
  7. Victor Tsang1,2,
  8. Christina Pagel3 and
  9. Martin Utley3
  1. 1Cardiac Unit, Great Ormond Street Hospital for Children, London, UK
  2. 2Institute for Cardiovascular Science, University College London, London, UK
  3. 3Clinical Operational Research Unit, University College London, London, UK
  4. 4Department of Paediatric Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  5. 5Cardiac Surgery Department, The Royal Hospital for Sick Children, Glasgow, UK
  6. 6National Institute for Cardiac Outcomes Research (NICOR), University College London, London, UK
  7. 7Cardiac Surgery Department, Birmingham Children's Hospital, Birmingham, UK
  1. Correspondence to Martin Utley; m.utley{at}ucl.ac.uk

Abstract

Objectives To explore changes over time in the 30-day mortality rate for paediatric cardiac surgery and to understand the role of attendant changes in the case mix.

Methods, setting and participants Included were: all mandatory submissions to the National Institute of Cardiovascular Outcomes Research (NICOR) relating to UK cardiac surgery in patients aged <16 years. The χ2 test for trend was used to retrospectively analyse the proportion of surgical episodes ending in 30-day mortality and with various case mix indicators, in 10 consecutive time periods, from 2000 to 2010. Comparisons were made between two 5-year eras of: 30-day mortality, period prevalence and mean age for 30 groups of specific operations.

Main outcome measure 30-day mortality for an episode of surgical management.

Results Our analysis includes 36 641 surgical episodes with an increase from 2283 episodes in 2000 to 3939 in 2009 (p<0.01). The raw national 30-day mortality rate fell over the period of review from 4.3% (95% CI 3.5% to 5.1%) in 2000 to 2.6% (95% CI 2.2% to 3.0%) in 2009/2010 (p<0.01). The case mix became more complex in terms of the percentage of patients <2.5 kg (p=0.05), with functionally univentricular hearts (p<0.01) and higher risk diagnoses (p<0.01). In the later time era, there was significant improvement in 30-day mortality for arterial switch with ventricular septal defect (VSD) repair, patent ductus arteriosus ligation, Fontan-type operation, tetralogy of Fallot and VSD repair, and the mean age of patients fell for a range of operations performed in infancy.

Conclusions The raw 30-day mortality rate for paediatric cardiac surgery fell over a decade despite a rise in the national case mix complexity, and compares well with international benchmarks. Definitive repair is now more likely at a younger age for selected infants with congenital heart defects.

  • CONGENITAL HEART DISEASE
  • QUALITY OF CARE AND OUTCOMES

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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