Author + information
- Received June 19, 2019
- Revision received September 1, 2019
- Accepted September 5, 2019
- Published online November 25, 2019.
- Michael Gaies, MD, MPH, MSa,∗ (, )@Mgaies,
- Sara K. Pasquali, MD, MHSa,
- Mousumi Banerjee, PhDb,
- Justin B. Dimick, MD, MPHc,
- John D. Birkmeyer, MDd,
- Wenying Zhang, MSe,
- Jeffrey A. Alten, MDf,
- Nikhil Chanani, MDg,
- David S. Cooper, MDf,
- John M. Costello, MD, MPHh,
- J. William Gaynor, MD, PhDi,
- Nancy Ghanayem, MDj,
- Jeffrey P. Jacobs, MDk,
- John E. Mayer, MDl,
- Richard G. Ohye, MDm,
- Mark A. Scheurer, MDh,
- Steven M. Schwartz, MDn,
- Sarah Tabbutt, MD, PhDo and
- John R. Charpie, MD, PhDa
- aDepartment of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
- bDepartment of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
- cDepartment of Surgery, University of Michigan Medical School, Ann Arbor, Michigan
- dSound Physicians, Tacoma, Washington
- eCenter for Health Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
- fDepartment of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- gDepartment of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- hDepartment of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
- iDepartment of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- jDepartment of Pediatrics, Baylor College of Medicine, Houston, Texas
- kThe Society of Thoracic Surgeons, Chicago, Illinois
- lDepartment of Cardiac Surgery, Harvard Medical School, Boston, Massachusetts
- mDepartment of Cardiac Surgery, University of Michigan Medical School, Ann Arbor, Michigan
- nDepartments of Pediatrics and Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- oDepartment of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, California
- ↵∗Address for correspondence:
Dr. Michael Gaies, University of Michigan Congenital Heart Center, C.S. Mott Children’s Hospital, 1540 East Hospital Drive, Ann Arbor, Michigan 48109-4204.
Background Patients undergoing complex pediatric cardiac surgery remain at considerable risk of mortality and morbidity, and variation in outcomes exists across hospitals. The Pediatric Cardiac Critical Care Consortium (PC4) was formed to improve the quality of care for these patients through transparent data sharing and collaborative learning between participants.
Objectives The purpose of this study was to determine whether outcomes improved over time within PC4.
Methods The study analyzed 19,600 hospitalizations (18 hospitals) in the PC4 clinical registry that included cardiovascular surgery from August 2014 to June 2018. The primary exposure was 2 years of PC4 participation; this provided adequate time for hospitals to accrue data and engage in collaborative learning. Aggregate case mix–adjusted outcomes were compared between the first 2 years of participation (baseline) and all months post-exposure. We also evaluated outcomes from the same era in a cohort of similar, non-PC4 hospitals.
Results During the baseline period, there was no evidence of improvement. We observed significant improvement in the post-exposure period versus baseline for post-operative intensive care unit mortality (2.1% vs. 2.7%; 22% relative reduction [RR]; p = 0.001), in-hospital mortality (2.5% vs. 3.3%; 24% RR; p = 0.001), major complications (10.1% vs. 11.5%; 12% RR; p < 0.001), intensive care unit length of stay (7.3 days vs. 7.7 days; 5% RR; p < 0.001), and duration of ventilation (61.3 h vs. 70.6 h; 13% RR; p = 0.01). Non-PC4 hospitals showed no significant improvement in mortality, complications, or hospital length of stay.
Conclusions This analysis demonstrates improving cardiac surgical outcomes at children’s hospitals participating in PC4. This change appears unrelated to secular improvement trends, and likely reflects PC4’s commitment to transparency and collaboration.
Dr. Gaies was supported in part by funding from the National Institutes of Health/National Heart, Lung, and Blood Institute (K08HL116639). This study was supported in part by the National Heart, Lung, and Blood Institute (R01HL12226 to Dr. Pasquali). Dr. Pasquali also received support from the Janette Ferrantino Professorship, University of Michigan. The PC4 Data Coordinating Center receives funding from the University of Michigan Congenital Heart Center, CHAMPS for Mott, and the Michigan Institute for Clinical & Health Research (NIH/NCATS UL1TR002240), all University of Michigan. Drs. Dimick and Birkmeyer are cofounders and equity owners of ArborMetrix, which provides software and analytic support to the Pediatric Cardiac Critical Care Consortium. Dr. Jacobs has served as a consultant for SpecialtyCare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 19, 2019.
- Revision received September 1, 2019.
- Accepted September 5, 2019.
- 2019 American College of Cardiology Foundation
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