Document Detail

The complex relationship between center volume and outcome in patients undergoing the Norwood operation.
MedLine Citation:
PMID:  22014746     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Norwood outcomes vary across centers, and a relationship between center volume and outcome has been previously described. It is unclear whether this volume-outcome relationship exists across all levels of patient risk or holds true for all centers. We evaluated the impact of patient risk status on the relationship between center volume and outcome, and the extent to which differences in center volume account for between-center variation in outcome.
METHODS: Infants in The Society of Thoracic Surgeons Congenital Heart Surgery Database undergoing the Norwood operation (2000 to 2009) were included. Mortality associated with annual Norwood volume overall and across patient preoperative risk tertiles was evaluated in multivariable analysis. We also estimated the proportion of between-center variation in mortality explained by center volume.
RESULTS: The cohort included 2,557 infants from 53 centers: 34 centers with 0 to 10 Norwood cases per year; 13 centers with 11 to 20 cases per year; and 6 centers with more than 20 cases per year. Unadjusted in-hospital mortality was 22%. In multivariable analysis, lower center volume was associated with higher mortality (odds ratio in low-volume versus high-volume centers 1.54, 95% confidence interval: 1.02 to 2.32, p=0.04). The volume-outcome relationship did not differ across preoperative risk tertiles (p=0.7). Norwood volume explained an estimated 14% of the between-center variation in mortality observed, and significant between-center variation in mortality remained after adjusting for volume (p<0.001).
CONCLUSIONS: Center volume is modestly associated with outcome after the Norwood operation independent of patient risk status. However, this relationship explains only a portion of the between-center variation in mortality in this cohort.
Sara K Pasquali; Jeffrey P Jacobs; Xia He; Christoph P Hornik; Robert D B Jaquiss; Marshall L Jacobs; Sean M O'Brien; Eric D Peterson; Jennifer S Li
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2011-10-19
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  93     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-30     Completed Date:  2012-07-12     Revised Date:  2014-09-08    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1556-62     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Cause of Death
Cohort Studies
Confidence Intervals
Databases, Factual
Education, Medical, Continuing
Follow-Up Studies
Heart Defects, Congenital / diagnosis,  mortality,  surgery*
Hospital Mortality / trends*
Hospitals / utilization*
Infant, Newborn
Norwood Procedures / adverse effects,  methods,  mortality*
Odds Ratio
Postoperative Complications / mortality,  physiopathology
Retrospective Studies
Risk Assessment
Survival Analysis
Treatment Outcome
Workload / statistics & numerical data*
Grant Support
1K08HL103631-01/HL/NHLBI NIH HHS; K08 HL103631/HL/NHLBI NIH HHS; K08 HL103631-01/HL/NHLBI NIH HHS
Comment In:
Ann Thorac Surg. 2012 May;93(5):1562   [PMID:  22541186 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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