Background
Methods
Results
Study selection and characteristics
Author (pub year)
|
Study type
|
Region/country
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Data source
|
Period
|
Patient characteristics
|
Case definition (ICD-9-CM)
|
---|---|---|---|---|---|---|
Chang 2002 [34] (subgroup analysis) | Registry-based | US | NIS | 1988-1997 | Age ≤30 days at admission | 746.7 |
Gutgesell [35] 2002 | Registry-based | US | UHC | 1990-1999 | Age ≤30 days at admission | 746.7 + 39.61/34.42/37.4/38.34 to 38.85/39.56/39.0 |
Checchia 2005 [42] | Registry-based | US | PHIS | 1998-2001 | Age ≤30 days at admission | 746.7 + 39.0 |
Berry 2006 [33] | Registry-based | US | KID 1997 and 2000 | 1997 and 2000 |
Teaching vs. non-teaching:
| 746.5, 746.7, 747.10 + 39.0, 747.22 |
Age at admission in days, median (IQR): 1(0–6)/3(1–6) | ||||||
Male (%) 77/60 | ||||||
White (%) 64/62 | ||||||
Medicaid (%) 32/49 | ||||||
Noncardiac structural anomaly (%) 5/5 | ||||||
Prematurity/low birth weight (%) 7/5 | ||||||
Aortic atresia (%) 3/2 | ||||||
Chromosomal anomaly (%) 3/0 | ||||||
Hirsch 2008 [36] | Registry-based | US | KID 2003 | 2003 | Male 63.1% | 746.7 + 39.0 |
White 39.6% | ||||||
Non-white 33.5% | ||||||
Race unknown 26.9% | ||||||
Welke 2009 [23] (subgroup analysis) | Registry-based | US | STS-CHSDB | 2002-2006 | NR | NR |
Karamlou 2010 [39] | Clinical study | US + Canada | CHSS studies | 1994-2000 | NR | NR |
McHugh 2010 [40] | Registry-based | US | UHC | 1998-2007 | NR | 746.7 + 34.42/39.0/35.92/37.4/(38.34 to 38.85 + 39.61) |
Registry-based | US | STS-CHSDB | 2000-2009 | Mean age (days) 6 (IQR 4–9) | ||
Mean weight (kg) 3.18 (IQR 2.80-3.50) | ||||||
Weight <2.5 kg 9.7% | ||||||
Male 58.2% | ||||||
Noncardiac/genetic abnormality 19.9% | ||||||
Dominant ventricle: right 89.6%, left 8.0%, | ||||||
TAPVR 1.3% | ||||||
Mechanical ventilator support 39.9% | ||||||
Mechanical circulatory support 0.8% | ||||||
Shock 6.7% | ||||||
Arrhythmia 2.6% | ||||||
Neurologic deficit 1.3% | ||||||
Complete atrioventricular block 0.2% | ||||||
LOS >7 days 20.8% | ||||||
Tabbutt 2012 [41] | Clinical study | US | Pediatric Heart Network SVR trial | 05/2005-07/2008 | NR | NR |
Author (pub year)
|
N analysed
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Hospital type
|
Surgeon volume
|
Hospital volume
|
Model (adjustments)
| ||
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Chang 2002 [34] | 78 (1988–1992), 268 (1993–1997) | NI | NI | Hospital mortality | No model (volume treated as continuous variable; correlation coefficients) | ||
1988-1992 | r = -0.20 (p < 0.01) | ||||||
1993-1997 | r = -0.31 (p < 0.01) | ||||||
Gutgesell 2002 [35] | 1203 | NI | NI | Mortality | No model | ||
Low ≤ 50 | 50% | ||||||
High >50 | 40% | ||||||
Checchia 2005 [42] | 801 | NI | Survival | Survival | No model | ||
Low ≤4 | 49% | Low <16 | 48% | ||||
High >4 | 69% | Medium 16-30 | 62% | ||||
High >30 | 71% | ||||||
p = 0.08 | |||||||
Increase by 4% (95% CI 1%-7%) for every 10 additional procedures performed | Linear regression | ||||||
Trend for mortality p = 0.13 | Trend for mortality p = 0.02 | Volume treated as continuous variable | |||||
Association of risk-unadjusted mortality | Association of risk-unadjusted mortality | ||||||
r2 = NR, p = 0.312 | r2 = 0.18, p = 0.02 | ||||||
Mean LOS survivors (SD) | |||||||
Low <16 | 36.5 ± 32.4 | ||||||
Medium 16-30 | 28.7 ± 8.4 | ||||||
High >30 | 29.4 ± 5.7 | ||||||
p > 0.05 | |||||||
Mean TTD (SD) | |||||||
Low <16 | 19.6 ± 33.2 | ||||||
Medium 16-30 | 12.2 ± 9.7 | ||||||
High >30 | 20.2 ± 9.6 | ||||||
p > 0.05 | |||||||
Median TTD (range) | |||||||
Low <16 | 19.2 (1–104) | ||||||
Medium 16-30 | 5.4 (1–13) | ||||||
High >30 | 7.8 (1–27) | ||||||
p > 0.05 | |||||||
Berry 2006 [33] | 754 (1997), 880 (2000) | Non-teaching vs. teaching | Hospital mortality | NI | Hospital mortality | Logistic regression (teaching status, hospital volume, noncardiac structural anomaly, prematurity, low birth weight, aortic atresia, chromosomal anomaly) | |
OR 2.6 (1.3 - 5.3) | Low | OR 3.1 (1.1 – 8.3) | |||||
Mid-low | OR 2.0 (0.7 – 5.7) | ||||||
Mid-high | OR 1.0 (0.5 – 1.8) | ||||||
High | reference | ||||||
(Categories were determined from quartiles) | |||||||
Hirsch 2008 [36] | 624 | Hospital mortality | Mortality | ||||
Urban teaching | 24.4% | Inverse association p = 0.0001 | Logistic regression (volume treated as continuous variable) | ||||
Urban non-teach. | 32.2% | ||||||
Rural | 34.0% | ||||||
Unknown | 26.6% | ||||||
Welke 2009 [23] | 1154 | NI | NI | Mortality | Logistic regression (age, age-for-weight-and-sex z score, interaction between age and age-for-weight-and-sex z score, preoperative stay for more than 2 days; number of prior operations (0, 1, ≤2); renal failure or dialysis, acidosis, circulatory support or shock; preoperative ventilator support or tracheostomy; asplenia, polysplenia, or a22q11 deletion; DiGeorge syndrome; Down syndrome; procedure or procedure group; operation date | ||
Low <150 | OR 2.91 (1.98-4.28) | ||||||
Medium 150-249 | OR 1.59 (1.09-2.32) | ||||||
High 250-349 | OR 1.43 (1.06-1.95) | ||||||
Very high ≥350 | Reference | ||||||
Volume categories for pediatric cardiac surgery | p = 0.002 when hospital volume analysed as continuous variable (test of no volume mortality relationship) | ||||||
Karamlou 2010 [39] | 710 | NI | Mortality | Mortality | Hazard regression (Birth weight, age at operation, circulatory arrest time, ascending aortic dimension, reimplantation of the ascending aorta, shunt origin from the aorta) | ||
Increased cases per year (per case): -0.004 ± 0.007 (p = 0.49) [parameter estimate ± SE] | Increased cases per year (per case): -0.005 ± 0.01 (p = 0.38) [parameter estimate ± SE] | ||||||
McHugh 2010 [40] | 1949 | NI | NI | Hospital mortality | Logistic regression (?) | ||
Low <20 | OR 2.49 (1.51-4.07) | ||||||
Medium 20-64 | OR 1.75 (1.23-2.49) | ||||||
High >64 | Reference | ||||||
2555 | NI | Hospital mortality | Hospital mortality | Logistic regression (all patient characteristics, hospital volume/surgeon volume) | |||
Low ≤5 | OR 1.47 (1.01-2.15 | Low ≤10 | OR 1.37 (0.92-2.05) | ||||
Medium 6-10 | OR 1.26 (0.88-1.78) | Medium 11-20 | OR 1.20 (0.80-1.82) | ||||
High >10 | Reference | High >20 | Reference | ||||
OR 1.17 (1.01-1.35) for a twofold decrease in hospital volume | Volume treated as continuous variable | ||||||
Tabbutt 2012 [41] | 549 | NI | Renal failure | Renal failure | Logistic regression (anomalous pulmonary venous return, preoperative intubation, heart block, open sternum, volume) | ||
Low ≤5 | OR 0.31 (0.09-1.09) | Low ≤15 | OR 1.55 (0.53-4.58) | ||||
Medium 6 to 10 | OR 0.90 (0.28-2.91) | Medium 16 to 20 | OR 0.44 (0.14-1.45) | ||||
High 11 to 15 | OR 0.20 (0.06-0.61) | High 21 to 30 | OR 0.32 (0.11-0.91) | ||||
Very high >15 | Reference | Very high >30 | Reference | ||||
Log time to first extubation in days | Log time to first extubation in days | Linear regression (gestational age, left atrial decompression, TR preoperatively, duration of regional cerebral perfusion, ECMO, open sternum, duration of open sternum, operations after Norwood procedure, volume) | |||||
Low ≤5 | 0.54 | Low ≤15 | -0.06 | ||||
Medium 6 to 10 | 0.54 | Medium 16 to 20 | 0.31 | ||||
High 11 to 15 | 0.40 | High 21 to 30 | 0.21 | ||||
Very high >15 | Reference | Very high >30 | Reference | ||||
Log length of ventilation in days | Log length of ventilation in days | Linear regression (gestational age, genetic abnormality, preoperative intubation, left atrial decompression, preoperative shock, TR preoperatively, age, open sternum, operations after Norwood procedure, volume) | |||||
Low ≤5 | 0.33 | Low ≤15 | 0.004 | ||||
Medium 6 to 10 | 0.27 | Medium 16 to 20 | 0.26 | ||||
High 11 to 15 | 0.21 | High 21 to 30 | 0.12 | ||||
Very high >15 | Reference | Very high >30 | Referene | ||||
Log time hospital LOS in days | Linear regression (birth weight, genetic abnormality, preoperative intubation for shock, TR preoperative, duration of DHCA, operations after Norwood procedure, volume) | ||||||
Low ≤15 | 0.16 | ||||||
Medium 16 to 20 | 0.34 | ||||||
High 21 to 30 | -0.03 | ||||||
Very high >30 | reference | ||||||
Sepsis | Logistic regression (gestational age, AS/MS/VD, duration of DHCA, open sternum duration, volume) | ||||||
Low ≤15 | OR 2.28 (1.17-4.47) | ||||||
Medium 16 to 20 | OR 0.94 (0.40-2.19) | ||||||
High 21 to 30 | OR 0.64 (0.33-1.26) | ||||||
Very high >30 | reference |
Study quality
Study
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Representativeness of study cohort
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Ascertainment of intervention
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Comparability of intervention and comparison/control group
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Assessment of outcomes
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Addressing incomplete data/quality of registry data
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Missing data on primary interventions and outcomes/selection of patients
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Register based studies
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Chang 2002 [34] |
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Gutgesell 2002 [35] |
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Checchia 2005 [42] |
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Berry 2006 [33] |
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Hirsch 2008 [36] |
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Welke 2009 [23] |
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McHugh 2010 [40] |
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clinical studies
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Karamlou 2010 [39] |
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Tabbutt 2012 [41] |
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