Improvement in Pediatric Cardiac Surgical Outcomes Through Interhospital Collaboration

J Am Coll Cardiol. 2019 Dec 3;74(22):2786-2795. doi: 10.1016/j.jacc.2019.09.046.


Background: Patients undergoing complex pediatric cardiac surgery remain at considerable risk of mortality and morbidity, and variation in outcomes exists across hospitals. The Pediatric Cardiac Critical Care Consortium (PC4) was formed to improve the quality of care for these patients through transparent data sharing and collaborative learning between participants.

Objectives: The purpose of this study was to determine whether outcomes improved over time within PC4.

Methods: The study analyzed 19,600 hospitalizations (18 hospitals) in the PC4 clinical registry that included cardiovascular surgery from August 2014 to June 2018. The primary exposure was 2 years of PC4 participation; this provided adequate time for hospitals to accrue data and engage in collaborative learning. Aggregate case mix-adjusted outcomes were compared between the first 2 years of participation (baseline) and all months post-exposure. We also evaluated outcomes from the same era in a cohort of similar, non-PC4 hospitals.

Results: During the baseline period, there was no evidence of improvement. We observed significant improvement in the post-exposure period versus baseline for post-operative intensive care unit mortality (2.1% vs. 2.7%; 22% relative reduction [RR]; p = 0.001), in-hospital mortality (2.5% vs. 3.3%; 24% RR; p = 0.001), major complications (10.1% vs. 11.5%; 12% RR; p < 0.001), intensive care unit length of stay (7.3 days vs. 7.7 days; 5% RR; p < 0.001), and duration of ventilation (61.3 h vs. 70.6 h; 13% RR; p = 0.01). Non-PC4 hospitals showed no significant improvement in mortality, complications, or hospital length of stay.

Conclusions: This analysis demonstrates improving cardiac surgical outcomes at children's hospitals participating in PC4. This change appears unrelated to secular improvement trends, and likely reflects PC4's commitment to transparency and collaboration.

Keywords: cardiac surgery; collaborative learning; congenital; outcomes; pediatric; quality.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cardiac Surgical Procedures / standards*
  • Child, Preschool
  • Cooperative Behavior*
  • Critical Care / organization & administration*
  • Female
  • Heart Defects, Congenital / surgery*
  • Hospital Mortality / trends
  • Humans
  • Infant
  • Infant, Newborn
  • Intensive Care Units / organization & administration*
  • Male
  • Morbidity / trends
  • Postoperative Complications / epidemiology*
  • Quality Improvement / organization & administration*
  • Registries
  • United States / epidemiology