The Journal of thoracic and cardiovascular surgery · 2026
25-Year outcomes following the regionalization of three competing pediatric cardiac surgery programs.
СтатьяМногоцентровое исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Alfieris George M, Swartz Michael F, Atallah-Yunes Nader, Pratt Rebecca E, Egan Matthew, Yoshitake Shuichi, Meagher Cecilia, Orie Joseph D, Smith Frank C
Аннотация
OBJECTIVE: The concept of regionalizing pediatric cardiac surgery centers to elevate care, increase surgeon volume, and improve outcomes has been discussed for several decades. We examined the outcomes after regionalizing 3 competing pediatric cardiac surgery programs.
METHODS: The procedures from children (<18 years of age) requiring pediatric cardiac surgery between 1991 and 2024 were divided into 2 groups: (1) preregionalization (1991-1998) when surgery was performed by 3 independent programs (Buffalo, Syracuse, Rochester) and (2) regionalization (2000-2024) when surgery was performed by 1 program at 2 sites (Syracuse, Rochester). Geographic information system software estimated the travel distance between the patient's residence and the surgical center. Logistic regression evaluated the impact of regionalization on hospital mortality.
RESULTS: From 7234 procedures, 2326 were performed during preregionalization and 4908 after regionalization. Surgeon volume (72.5 [interquartile range, 67.4-85.8 cases/year] vs 193.0 [interquartile range, 88.0-216.5 cases/year]; P < .001), the percentage of neonatal procedures (17.3% vs 24.0%; P < .001), and risk-adjusted congenital heart surgery 5 and 6 cases (2.3% vs 4.8%; P < .001) increased significantly after regionalization. Travel distance was longer (20.0 [interquartile range, 19.0-78.0 miles] vs 78.0 [interquartile range, 32.0-88.0 miles]; P < .001), but the rates of unplanned reoperation (5.4% vs 1.5%; P < .0001) and mortality (6.7% vs 4.2%; P < .001) were lower after regionalization. Multivariable analysis demonstrated that regionalization independently lowered mortality (odds ratio, 0.483, 95% CI, 0.306-0.761; P = .002).
CONCLUSIONS: After regionalization, travel distance and surgeon volume increased, and mortality decreased. Our model suggests that regionalizing pediatric cardiac surgical programs can increase surgeon volume and improve outcomes.
METHODS: The procedures from children (<18 years of age) requiring pediatric cardiac surgery between 1991 and 2024 were divided into 2 groups: (1) preregionalization (1991-1998) when surgery was performed by 3 independent programs (Buffalo, Syracuse, Rochester) and (2) regionalization (2000-2024) when surgery was performed by 1 program at 2 sites (Syracuse, Rochester). Geographic information system software estimated the travel distance between the patient's residence and the surgical center. Logistic regression evaluated the impact of regionalization on hospital mortality.
RESULTS: From 7234 procedures, 2326 were performed during preregionalization and 4908 after regionalization. Surgeon volume (72.5 [interquartile range, 67.4-85.8 cases/year] vs 193.0 [interquartile range, 88.0-216.5 cases/year]; P < .001), the percentage of neonatal procedures (17.3% vs 24.0%; P < .001), and risk-adjusted congenital heart surgery 5 and 6 cases (2.3% vs 4.8%; P < .001) increased significantly after regionalization. Travel distance was longer (20.0 [interquartile range, 19.0-78.0 miles] vs 78.0 [interquartile range, 32.0-88.0 miles]; P < .001), but the rates of unplanned reoperation (5.4% vs 1.5%; P < .0001) and mortality (6.7% vs 4.2%; P < .001) were lower after regionalization. Multivariable analysis demonstrated that regionalization independently lowered mortality (odds ratio, 0.483, 95% CI, 0.306-0.761; P = .002).
CONCLUSIONS: After regionalization, travel distance and surgeon volume increased, and mortality decreased. Our model suggests that regionalizing pediatric cardiac surgical programs can increase surgeon volume and improve outcomes.