Original article
Congenital heart surgery
Hospital Variation in Postoperative Infection and Outcome After Congenital Heart Surgery

Presented at the Forty-ninth Annual Meeting of The Society of Thoracic Surgeons, Los Angeles, CA, Jan 26–30, 2013.
https://doi.org/10.1016/j.athoracsur.2013.04.024Get rights and content

Background

Several initiatives aim to reduce postoperative infection across a variety of surgical patients as a means to improve overall quality of care and reduce variation across centers. However, the association of infection rates with hospital-level outcomes and resource utilization has not been well described. We evaluated this association across a multicenter cohort undergoing congenital heart surgery.

Methods

The Society of Thoracic Surgeons Congenital Heart Surgery Database was linked to resource utilization data from the Pediatric Health Information Systems Database for hospitals participating in both (2006 to 2010). Hospital-level infection rates (sepsis, wound infection, mediastinitis, endocarditis, pneumonia) adjusted for patient risk factors and case mix were calculated using Bayesian methodology, and association with hospital mortality rates, postoperative length of stay (LOS), and total costs evaluated.

Results

The cohort included 32,856 patients (28 centers); 3.7% had a postoperative infection. Across hospitals, the adjusted infection rate varied from 0.9% to 9.8%. Hospitals with the highest infection rates had longer (LOS) (13.2 vs 11.7 days, p < 0.001) and increased hospital costs ($71,100 vs $65,100, p < 0.001), but similar mortality rates (odds ratio 0.99, 95% confidence interval 0.80 to 1.21, p = 0.9). The proportion of variation in costs and LOS explained by infection was 15% and 6%, respectively.

Conclusions

Infection after congenital heart surgery contributes to prolonged LOS and increased costs on a hospital level. However, given that infection rates alone explained relatively little of the variation in these outcomes across hospitals, further study is needed to identify additional factors that may be targeted in initiatives to reduce variation and improve outcomes across centers.

Section snippets

Data Source

De-identified data from the STS-CHS and PHIS databases were linked at the individual patient level using the method of “indirect identifiers” as previously described and verified 7, 8, 9. The STS-CHS Database is the largest existing pediatric heart surgery registry, and collects data on all children undergoing heart surgery at greater than 100 participating North American centers. The PHIS Database is a large administrative database that collects information from the hospital bill from 41 US

Study Population

The study cohort included 32,856 patients from 28 centers. Patient characteristics overall and in those with and without infection are displayed in Table 1. The unadjusted rate of postoperative infection in the overall study population was 3.7%, and was highest in the following subgroups of patients: any noncardiac or genetic abnormality (5.3%), STAT categories 4-5 (7.5%), neonates (8.4%), and those with delayed sternal closure (11.5%). The types of infection are displayed in Table 2. Sepsis

Comment

In this multi-institutional analysis, we found that postoperative infection rates after congenital heart surgery varied widely across hospitals. Hospitals with higher infection rates had significantly longer LOS and increased costs. However, the magnitude of these differences was relatively small, with infection rates alone explaining only 15% of the total variation in costs and 6% of the total variation in LOS across hospitals.

This study supports the results of previous analyses which have

References (22)

  • Partnership for patients: Better care, lower costs. Available at:...
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    Dr. Pasquali's current affiliation is Department of Pediatrics, University of Michigan C. S. Mott Children's Hospital, Ann Arbor, MI.

    Co-senior authors.

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