Hospital Volume and Noncardiac Surgery Outcomes for Patients With Congenital Heart Disease.

OBJECTIVES

Mortality when undergoing noncardiac surgery for patients with congenital heart disease (CHD) remains higher than for patients without CHD. We sought to determine the impact of institutional volume on outcomes for noncardiac surgery for patients with CHD.

DESIGN

Retrospective database study.

PARTICIPANTS

Inpatients undergoing noncardiac procedures identified using the Pediatric Health Information System (2016-2023) were included in the assessment. Data were organized by hospital volume quintile, based on the number of patients with CHD undergoing noncardiac procedures.

MEASUREMENTS AND MAIN

RESULTS

Of 662,680 patients undergoing noncardiac surgery, 617,396 had no CHD, 23,712 had simple heart disease, 16,243 had complex heart disease, and 5,329 had single-ventricle disease. Quintile 1 hospitals performed fewer than 500 noncardiac procedures for patients with CHD over the study period, quintile 3 hospitals performed 900 to less than 1,100, and quintile 5 hospitals performed more than 1,500. Demographics were similar across volume quintiles. Mortality was highest in quintile 3 among the full cohort (0.83%, p < 0.001), the non-CHD cohort (0.56%, p = 0.009), and the complex CHD cohort (6.28%, p = 0.024). For simple and single-ventricle lesions, in-hospital mortality rates were similar across quintiles. The longest length of stay varied, including quintile 3 (simple), quintile 1 (complex), and quintiles 2 and 3 (single ventricle). In multivariable analysis, volume quintile 3 was associated with higher in-hospital mortality (adjusted odds ratio 1.14, 95% confidence interval 1.01-1.3, p = 0.034).

CONCLUSIONS

In-hospital mortality is higher for patients with CHD undergoing noncardiac surgery at mid-volume centers; length of stay demonstrates a more variable pattern. The reasons for such differences and the implications for regionalization of care require further study.