Center Volume and Failure to Rescue in Pediatric Cardiac Surgery: Is There a Relationship?

BACKGROUND: Failure to rescue (FTR) is a validated quality metric for evaluating outcomes in pediatric cardiac surgery. Using a national administrative database, we sought to assess the relationship between annual hospital case volume and FTR.

METHODS: Cardiopulmonary bypass (CPB) cases were extracted from the Kids' Inpatient Database for 2016 and 2019. FTR was defined as inpatient mortality of patients with at least 1 postoperative complication. Hospitals were divided into high-, mid-, and low-volume hospitals on the basis of annual CPB case volume terciles. A mixed effects multivariable logistic model was created to evaluate the association of annual CPB case volume and FTR. By use of the mean adjusted FTR rate of the entire sample as the benchmark, hospitals were divided into underperformers and overperformers.

RESULTS: A total of 10,528 patients had 1 or more complications during the same admission. There were 134 hospitals in the low-volume group, 64 in the mid-volume group, and 31 in the high-volume group. The risk-adjusted FTR rate was 4.04% for the entire cohort. Compared with low-volume hospitals at baseline, there was no statistically significant difference in FTR for mid-volume hospitals (odds ratio, 0.8; 95% CI, 0.61-1.1; P = .184) or high-volume hospitals (odds ratio, 0.8; 95% CI, 0.6-1.1; P = .201). There were underperforming and overperforming hospitals in all volume groups.

CONCLUSIONS: This real-world contemporary analysis highlights that hospital volume is not associated with FTR after pediatric cardiac surgery. Underperformers and overperformers exist in all volume groups. Volume may not be a reliable quality metric for comparing outcomes in pediatric cardiac surgery.