Children who have heart surgery at high-volume hospitals may fare better than those who are treated in hospitals that perform fewer paediatric cardiac surgeries per year, but this is not due to volume alone.
New research suggests that the busier centres are more able to spot and handle complications should they occur after heart surgery.
Of more than 35 000 children who had heart surgery at 68 hospitals, nearly 4% of children died in the hospital, and almost 41% experienced at least one complication after their surgery, a new study found.
Centers that performed more than 350 surgeries a year were considered "high volume", while those that performed fewer than 150 heart surgeries in children each year were "low volume". The complication rate was similar across all centres.
That said, the risk for dying after a major complication was higher at hospitals that performed fewer than 150 paediatric heart surgeries a year, when compared to those centres where more than 350 heart surgeries were performed a year, the study showed.
The new findings appear online and print issue of Paediatrics.
"Higher mortality observed at lower-volume centres appears to be relate to a higher rate of death in those who suffer a postoperative complication, rather than a higher rate of complications alone," said study author Dr Sara Pasquali, director of paediatric cardiovascular outcomes at Duke University Medical Centre in Durham, NC. "This suggests that initiatives aimed at improving patients outcomes may need to focus not only on reducing complications themselves, but on better recognition and management of complications once they occur."
Higher volume hospitals have better outcomes
Parents of a child in need of heart surgery may feel both scared and overwhelmed by the entire prospect and process.
"Several studies have now found that higher volume hospitals tend to have better outcomes, particularly for more complex cases," Pasquali said. "Volume is not the only important factor and that there are smaller hospitals with outcomes comparable to those at larger centres.
Overall, a hospital's past track record with similar types of cases may be the best information to consider rather than relying upon the volume of the center alone."
Dr Rubin Cooper, chief of paediatric cardiology at Cohen Children's Medical Centre in New Hyde Park, NY, said high-volume centres are not always an option based on where a patient lives and the urgency of the surgery.
"There aren't that many centres that do so much," Cohen said. "High-volume centres may have more tools and more surveillance, but low-volume centres all have board-certified people who are trained to know what they can and can't do, and they certainly would refer a case that they could not handle.
Some children do need highly specialised centres if they have a rare condition." However, he added, "I would say as many as 80% of paediatric heart patients can be treated by nearly all of the programme."
(HealthDay, Denise Mann, January 2012)
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