Major Finding: Adolescents undergoing surgery for congenital heart disease have a mortality rate of 0.15% when the procedure is done in a children's hospital, compared with 0.7% when the surgery is done in an adult hospital, and 2.1% when the surgery is done in an adult hospital with a children's unit.
Data Source: A national sample representing 22 million hospital discharges of patients aged 20 years and below during 2000, 2003, and 2006.
Disclosures: The investigators stated that they had no financial disclosures related to this work.
OJAI, CALIF. — Congenital heart surgery, once confined to infants and very young children, is increasingly being performed on older children and adults, the result of more effective medical and surgical treatments. A new study of a nationally representative database of pediatric hospital admissions has now shown that older children have a significantly lower mortality rate when their surgery is performed at a children's hospital instead of an adult hospital.
In 2006, for example, the mortality rate from congenital heart surgery for children and adolescents aged 14-20 years was 0.15% when the surgery was performed in a children's hospital. This is significantly lower than the mortality rate of 0.7% when the surgery was performed in an adult hospital or 2.1% when the surgery was performed in an adult hospital with a children's unit, Dr. Jeffrey S. Heinle reported at the annual meeting of the Western Thoracic Surgical Association.
“The vast majority of adolescent patients continue to be cared for in adult hospitals without a congenital unit,” said Dr. Heinle of the Baylor College of Medicine, Houston. “If you do a large volume of congenital cases, your outcomes in adult patients are better. … Even lesions we would consider simple, such as a ventricular septal defect in an adult, are better cared for with better outcomes by congenital heart surgeons rather than adult surgeons.”
The investigators used data from the Healthcare Cost and Utilization Project Kids' Inpatient Database, which provides nationally representative estimates of pediatric hospital discharges. Data for the 3 years studied—2000, 2003, and 2006—represent 22 million discharges, of which about 190,000 (0.8%) were for congenital heart surgery.
The number of congenital heart surgeries increased from about 57,000 in 2000 to about 70,000 in 2006. During that time the median age of children receiving congenital heart surgery rose significantly, from 6 years in 2000 to 8 years in 2003 and to 9 years in 2006.
The proportion of infant surgeries remained at about 33% during all 3 years studied. The proportion of surgeries in children aged 1-13 years decreased significantly from 29% to 23%. And the proportion of surgeries in adolescents aged 14-20 years increased significantly from 38% to 44%.
The in-hospital mortality rate declined significantly in infants, from 8.5% to 7.1%; and in adolescents, from 1.7% to 1.1%. Mortality remained between 1.5% and 1.7% for children aged 1-13 years.
The mean length of hospital stay rose significantly, from 13.7 days in 2000 to 16.3 days in 2006. This increase was driven largely by the increase in infants' average length of stay, from 29 to 38 days.
Infants and children 1-13 years of age were much more likely to be treated in a children's hospital or an adult hospital with a children's unit than in an adult hospital without a children's unit. On the other hand, about 75% of adolescents were treated in an adult hospital without a children's unit.
It wasn't only adolescents who had lower mortality when treated in a children's hospital. Infants too had significantly lower mortality: 6.1%, compared with 7.4% in adult hospitals and 7.7% in adult hospitals with a children's unit.