Quantification of Congenital Heart Disease Surgical Outcomes 2012-2015: a Four-Year Experience with the International Quality Improvement Collaborative Program

pp. 244-249

Abstract

Background: The health care system is having increasing interest in crossing the quality chasm. Surgery for congenital heart defects has improved in terms of outcomes and quality of life; however, the risk of mortality and infection needs to be quantified. The goal of this study was to quantify surgical outcomes of congenital heart diseases following the International Quality Improvement Collaborative (IQIC) for Congenital Heart Disease program with the aim of improving them.

Methods: This observational and interventional study, including patients undergoing surgery for congenital heart defects between January 1, 2012 and December 31, 2015, was conducted at a tertiary children’s hospital in Cordoba, Argentina. The following variables were quantified: sex, age, weight, complexity-adjusted risk, unadjusted risk, standardized in-hospital mortality and infection ratios (observed rate/expected rate) with their corresponding 95% confidence intervals. The results were compared with the IQIC program benchmarks (1.0 = benchmarking data, <1= quality improvement). The IQIC guidelines based on 3 key drivers: safe perioperative practice, reduction of infections and team-based practice were implemented as intervention for improvement.

Results: A total of 373 surgical procedures for congenital heart defects were performed on 203 male and 170 female patients classified in Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1) risk categories. The six-monthly unadjusted mortality was 6%, 3%, 8%, 9%, 11%, 0%, 0% and 5%, respectively (benchmarking data 4-6%). The standardized in-hospital mortality ratios and their corresponding confidence intervals were 0.85 (0.23-2.18), 1.82 (0.79-3.59), 1.07 (0.39-2.34), and 0.36 (0.04-1.29), respectively. The six-monthly unadjusted infection was 24%, 23%, 25%, 14%, 13%, 6%, 9% and 16%, respectively (benchmarking data 5-7%). The standardized infection ratios and their corresponding confidence intervals were 1.89 (1.12-2.99), 1.87 (1.17-2.83), 2.0 (1.20- 3.12), 1.22 (0.61-2.18), respectively.

Conclusions: The implementation of the IQIC program for congenital heart diseases in a public tertiary hospital in Cordoba, Argentina, contributed to quantify outcomes and introduce guidelines to improve them. While mortality decreased, the rate of infections needs still to be improved.