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Quality assurance of paediatric cardiac surgery: A prospective 6‐year analysis
Author(s) -
Justo RN,
Janes EF,
Sargent PH,
Jalali H,
Pohlner PG
Publication year - 2004
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/j.1440-1754.2004.00316.x
Subject(s) - medicine , cardiac surgery , incidence (geometry) , surgery , prospective cohort study , cardiopulmonary bypass , mortality rate , physics , optics
Objective: To audit effective quality assurance methods to monitor outcomes following paediatric cardiac surgery at a single institution. Methods: All patients undergoing cardiac surgery from January 1996 to December 2001 were enrolled prospectively. Patients were stratified by complexity of surgical procedure into four groups, with Category 4 being the most complex procedure. Outcome measures included death, length of admission and morbidity from complications. Results: A total of 1815 patients underwent 1973 surgical procedures. Of these, 1447 (73.3%) were cardiopulmonary bypass procedures, and 543 (27.5%) were more complex (Category 3 and 4) procedures. Median patient age was 3.5 years (range, 1 day−20 years) and patient weight 15.0 kg (range, 900 g to 90 kg). Sixty‐six patients (3.6%) died during the study period. Of the procedures in 1996, 22.7% were classified as complex compared with 29.2% of procedures in 2001. The annual surgical mortality ranged from 1.9−4.7% ( P = 0.20), and when mortality was adjusted for complexity of surgery, there was no significant yearly variation in the mortality rate ( P = 0.57). Analysis of individual surgeon's results showed no significant difference in the mortality rate by complexity of surgery performed ( P = 0.90). Mean ventilation times did not change significantly over time ( P = 0.79). The yearly incidence of significant neurological complications ranged from 0.6% to 4.5% and the incidence of arrhythmias from 4.2% to 8.0%. No difference was detected between the years. Conclusions: Stratifying complexity of surgery proved valuable in monitoring surgical outcomes and detecting differences in performance over time as large subgroups were created for analysis.