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Abstract
Originally Published 11 November 2016
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Abstract 11485: New Metrics of Postoperative Mechanical Ventilation Duration After Congenital Heart Surgery Reveal Variation Across Hospitals

Abstract

Background: Pediatric cardiac surgical programs aim to limit duration of postoperative mechanical ventilation (POMV) to reduce complications and hospital stay. Measuring casemix-adjusted duration of POMV across hospitals might elucidate differential performance and identify improvement opportunities.
Methods: All surgical hospitalizations in the Pediatric Cardiac Critical Care Consortium (PC4) clinical registry from 10/2013-8/2015 were used to create a model predicting casemix-adjusted total duration of POMV using zero-inflated negative binomial regression and validated with 1000 bootstrap samples. From the model we developed metrics based on observed-to-expected POMV: early extubation success/failure, POMV reduction, and total hours of POMV saved/lost (Table 1). We ranked hospitals on each metric (1-15, 1=best) and calculated an average ranking across metrics to identify high and low performing hospitals.
Results: The cohort included 4739 hospitalizations from 15 hospitals: 53% were infants and 22% had high complexity surgery. The final model included age, weight-for-age z-score, prematurity, pre-operative MV, extracardiac anomalies, procedure complexity, and bypass time. The model was well-calibrated to predict mean duration of POMV for groups of patients. Table 1 displays the range and median of hospital rates on each of the four metrics, demonstrating variation across the group. The average ranks across these POMV duration metrics suggested two positive outlying hospitals (average rank across all 4 metrics = 1.75) and five hospitals with consistently lower performance (average 8.75-11.25).
Conclusions: We developed novel casemix-adjusted metrics of hospital performance to limit duration of POMV following pediatric cardiac surgery, and identified wide variation in relative performance across centers. These metrics may suggest opportunities for improvement when evaluated in context with other perioperative quality measures.

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History

Published in print: 11 November 2016
Published online: 29 March 2018

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Keywords

  1. Congenital heart surgery, pediatric
  2. Pediatric cardiac intensive care
  3. Quality assessment
  4. Postoperative
  5. Health services research

Authors

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Michael Gaies
Pediatrics and Communicable Diseases, Univ of Michigan, Ann Arbor, MI
David Werho
Pediatrics, Stanford Univ Sch of Medicine, Palo Alto, CA
Nancy Ghanayem
Pediatrics, Med College of Wisconsin, Milwaukee, WI
Sarah Tabbutt
Pediatrics, Univ of California-San Francisco Sch of Medicine, San Francisco, CA
John Costello
Pediatrics, Feinberg Sch of Medicine Northwestern Univ, Chicago, IL
Mark Scheurer
Pediatrics, Med Univ of South Carolina, Charleston, SC
Sara K Pasquali
Pediatrics and Communicable Diseases, Univ of Michigan, Ann Arbor, MI
Janet Donohue
Pediatrics and Communicable Diseases, Univ of Michigan, Ann Arbor, MI
Wenying Zhang
Congenital Heart Cntr, Univ of Michigan, Ann Arbor, MI
Mousumi Banerjee
Biostatistics, Univ of Michigan, Sch of Public Health, Ann Arbor, MI
Steven Schwartz
Critical Care Medicine and Paediatrics, Univ of Toronto Faculty of Medicine, Toronto, Canada

Notes

Author Disclosures: M. Gaies: Research Grant; Significant; NIH/NHLBI K08HL116639. D. Werho: None. N. Ghanayem: None. S. Tabbutt: None. J. Costello: None. M. Scheurer: None. S.K. Pasquali: None. J. Donohue: None. W. Zhang: None. M. Banerjee: None. S. Schwartz: None.

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  1. Cardiac Database and Risk Factor Assessment, Outcomes Analysis for Congenital Heart Disease, Critical Care of Children with Heart Disease, (133-141), (2020).https://doi.org/10.1007/978-3-030-21870-6_12
    Crossref
  2. Critical Care Databases and Quality Collaboratives, Critical Heart Disease in Infants and Children, (58-63.e1), (2019).https://doi.org/10.1016/B978-1-4557-0760-7.00007-3
    Crossref
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