Comparing Apples to Apples: Exploring public reporting of congenital cardiac surgery outcomes based on common congenital heart operations.

OBJECTIVE: We sought to simplify reporting of outcomes in congenital heart surgery that compares well-defined patient groups, accommodates multiple stakeholder needs while being easily understandable.

METHODS: We selected 19 commonly performed congenital heart surgeries ranging in complexity from repair of atrial septal defects (ASD) to the Norwood procedure. Strict inclusion/exclusion criteria ensured the creation of 19 well defined diagnosis/procedure cohorts. Preoperative, procedural, and postoperative data were collected for consecutive eligible patients from 9 centers between 1/1/2016 to 12/31/2021. Unadjusted operative mortality rates and hospital length of stay for each of the 19 diagnosis/procedure cohorts were summarized in aggregate and stratified by each center.

RESULTS: Of 8572 eligible cases included, numbers in the 19 diagnosis/procedure cohorts ranged from 73 for tetralogy of Fallot repair after prior palliation to 1224 for ventricular septal defect (VSD) repairs for isolated VSD. In aggregate, the unadjusted mortality ranged from 0% for ASD repair to 28.4% for Hybrid Stage I. There was significant heterogeneity in case-mix and mortality for different diagnosis/procedure cohorts across centers (e.g., ASO/VSD n=7 to 42, mortality 0% to 7.4%; Norwood procedure n=16 to 122, mortality 5.3% to 25%).

CONCLUSION: Reporting of institutional case volumes and outcomes within well-defined diagnosis/procedure cohorts can enable centers to benchmark outcomes, understand trends in mortality, and direct quality improvement. When made public, this type of report could provide parents with information on institutional volumes and outcomes and allow them to better understand the experience of each program with operations for specific congenital heart defects.