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Publication Detail
Trends in 30-day mortality rate and case mix for paediatric cardiac surgery in the UK between 2000 and 2010.
  • Publication Type:
    Journal article
  • Publication Sub Type:
  • Authors:
    Brown KL, Crowe S, Franklin R, McLean A, Cunningham D, Barron D, Tsang V, Pagel C, Utley M
  • Publication date:
  • Pagination:
    e000157, ?
  • Journal:
    Open heart
  • Volume:
  • Issue:
  • Medium:
  • Status:
  • Print ISSN:
  • Language:
  • Addresses:
    Cardiac Unit , Great Ormond Street Hospital for Children , London , UK ; Institute for Cardiovascular Science, University College London, London , UK.
OBJECTIVES:To explore changes over time in the 30-day mortality rate for paediatric cardiac surgery and to understand the role of attendant changes in the case mix. METHODS SETTING AND PARTICIPANTS:Included were: all mandatory submissions to the National Institute of Cardiovascular Outcomes Research (NICOR) relating to UK cardiac surgery in patients aged <16 years. The χ(2) test for trend was used to retrospectively analyse the proportion of surgical episodes ending in 30-day mortality and with various case mix indicators, in 10 consecutive time periods, from 2000 to 2010. Comparisons were made between two 5-year eras of: 30-day mortality, period prevalence and mean age for 30 groups of specific operations. MAIN OUTCOME MEASURE:30-day mortality for an episode of surgical management. RESULTS:Our analysis includes 36 641 surgical episodes with an increase from 2283 episodes in 2000 to 3939 in 2009 (p<0.01). The raw national 30-day mortality rate fell over the period of review from 4.3% (95% CI 3.5% to 5.1%) in 2000 to 2.6% (95% CI 2.2% to 3.0%) in 2009/2010 (p<0.01). The case mix became more complex in terms of the percentage of patients <2.5 kg (p=0.05), with functionally univentricular hearts (p<0.01) and higher risk diagnoses (p<0.01). In the later time era, there was significant improvement in 30-day mortality for arterial switch with ventricular septal defect (VSD) repair, patent ductus arteriosus ligation, Fontan-type operation, tetralogy of Fallot and VSD repair, and the mean age of patients fell for a range of operations performed in infancy. CONCLUSIONS:The raw 30-day mortality rate for paediatric cardiac surgery fell over a decade despite a rise in the national case mix complexity, and compares well with international benchmarks. Definitive repair is now more likely at a younger age for selected infants with congenital heart defects.
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