Details

Autor(en) / Beteiligte

• Welke, Karl F., MD, MS
• Pasquali, Sara K., MD, MHS
• Lin, Paul, MS
• Backer, Carl L., MD
• Overman, David M., MD
• Romano, Jennifer C., MD, MS
• Karamlou, Tara, MD, MSc

Titel

Regionalization of Congenital Heart Surgery in the United States

Ist Teil von

• Seminars in thoracic and cardiovascular surgery, 2020, Vol.32 (1), p.128-137

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2020

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• The objective of this study is to simulate regionalization of congenital heart surgery (CHS) in the United States and assess the impact of such a system on travel distance and mortality. Patients ≤18 years of age that underwent CHS were identified in 2012 State Inpatient Databases. Operations were stratified by the Risk Adjustment for Congenital Heart Surgery, version 1 (RACHS-1) method, with high risk defined as RACHS-1 levels 4-6. Regionalization was simulated by progressive closure of hospitals, beginning with the lowest volume hospital. Patients were moved to the next closest hospital. Analyses were conducted 1) maintaining original hospital mortality rates and 2) estimating mortality rates based on predicted surgical volumes after absorbing moved patients. 153 hospitals from 36 states performed one or more operation (19,064 operations). With regionalization wherein, all hospitals performed > 310 operations, 37 hospitals remained, from 12.5 to 17.4% fewer deaths occurred (83-116/666), and median patient travel distance increased from 38.5 to 69.6 miles (p<0.01). When only high-risk operations were regionalized, 3.9 to 5.9% fewer deaths occurred (26-39/666) and the overall mortality rate did not change significantly. Regionalization of CHS in the United States to higher volume centers may reduce mortality with minimal increase in patient travel distance. Much of the mortality reduction may be missed if solely high-risk patients are regionalized.