Mortality rates after surgery for congenital heart defects in children and surgeons' performance

@article{Stark2000MortalityRA,
  title={Mortality rates after surgery for congenital heart defects in children and surgeons' performance},
  author={Jf Stark and Steve Gallivan and Jocelyn Lovegrove and Jrl Hamilton and J. L. Monro and J C Pollock and K G Watterson},
  journal={The Lancet},
  year={2000},
  volume={355},
  pages={1004-1007}
}
BACKGROUND A public inquiry into surgery for paediatric congenital heart defects in Bristol, UK, underscored the need for reliable data on overall mortality rates, which would allow assessment of individual surgeons' performance. We aimed to gather and report such data for 1 year to provide information for clinicians, researchers, policy makers, and the general public. METHODS We collected data on all operations (1378) for congenital heart defects done by 11 surgeons in five departments in… 
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Assessment of mortality rates for congenital heart defects and surgeons' performance.
TLDR
Estimates of mortality rates are more precise as reflected by tighter confidence intervals and for setting standards, data from more departments for a longer period will be required.
Mortality and volume of cases in paediatric cardiac surgery: retrospective study based on routinely collected data
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Mortality in paediatric cardiac surgery was inversely related to the volume of surgery, and it does not necessarily follow that concentrating resources in fewer centres would reduce mortality.
In pursuit of excellence: monitoring results and assessment of performance in congenital cardiac surgery
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Carter, founded the cardiothoracic unit at Great Ormond Street Hospital in London almost 50 years ago, speculated that the greatest improvement in the surgical treatment of children born with congenital cardiac malformations would come from the implementation of current knowledge and better organisation of work, rather than from the new research.
Evidence-based referral results in significantly reduced mortality after congenital heart surgery.
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Evidence-based referrals from a small-volume pediatric cardiac center to large-volume institutions resulted in a reduction in mortality after congenital heart surgery.
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Survival of neonates with complex congenital heart disease is influenced more by patient and management factors than by institution or surgeon experience, and weighted risk-adjusted comparisons could provide a mechanism to improve results in institutions with less than optimal outcomes.
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Pediatric shunt procedures performed at high-volume hospitals or by high- volume surgeons were associated with lower in-hospital mortality rates, with no significant difference in LOS or hospital charges.
The RACHS-1 risk categories reflect mortality and length of hospital stay in a large German pediatric cardiac surgery population.
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The RACHS-1 classification is applicable to European pediatric populations, too, and is able to classify patients into significantly different groups concerning total and postoperative hospital stay duration, although there remains a large variability within the groups.
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This issue of the Journal reports on the efforts made in developing an independent, well functioning center for pediatric cardiac surgery in Zagreb, Croatia, and indicates that Croatia now has a unique opportunity to develop an organized center with programs similar to those in the Western world.
The effect of surgical case volume on outcome after the Norwood procedure.
TLDR
Survival after the Norwood procedure is associated with institutional Norwood procedures volume but not with individual surgeon case volume, suggesting the need for improvements in institutional-based approaches to the care of children with hypoplastic left heart syndrome and the need to establish regional referral centers for such high-risk procedures to improve patient survival.
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