We identified patients in the Pediatric Health Information System in Risk Adjustment for Congenital Heart Surgery 1 category 1 to 6 for 32 pediatric cardiac surgical procedures conducted between 2003 and 2011 (n?=?67,550). These were examined for their overall contribution to mortality, intensive care unit and hospital lengths of stay (coefficient of variation and excess days), adverse events, and readmission rates. A ranking scheme was created on the basis of the outcome measures. Then we ordered the procedures across metrics to develop a prioritization scheme.
Observed mortality rates were consistent with published rates. A few procedures accounted for significant variation in hospital and intensive care length of stay across the hospitals. Likewise, a few procedures accounted for most excess days of stay and readmission rates. Up to 60 % of the hospital stay was accounted for by intensive care unit stay. Although there was a linear relationship between adverse event rates and Risk Adjustment for Congenital Heart Surgery 1 categories, a few procedures once again accounted for disproportionate event rates within and across their respective Risk Adjustment for Congenital Heart Surgery 1 categories.
A small number of procedures account for a substantial burden of morbidity, even among low mortality risk groups. Consideration should be given to using such objective prioritization schemes to develop targeted quality-improvement measures.