Original articleCongenital heart surgeryHigher Programmatic Volume in Neonatal Heart Surgery Is Associated With Lower Early Mortality
Section snippets
Material and Methods
The study was carried out according to the ECHSA Congenital Database policy (available at: www.echsacongenitaldb.org, paragraph 2). Because the individual patients were not identified, the ECHSA Congenital Database Committee waived the need for parental consent. The ECHSA database director, according to the policy of the database, accepted the study.
Centers
We identified 27,556 of 29,234 operations in the ECHSA congenital database from January 1, 1999, to December 31, 2015, from 90 centers that met our inclusion criteria. By definition, the minimal data set of these records are complete. These numbers were collected in a total of 722 center-years, making for an average of 8 years per center (SD 4.2; range, 3 to 17). The mean annual neonatal cardiac surgical volume was 1,628 operations per year for the entire cohort (SD 724; range, 116 to 2,414);
Comment
The risk-adjusted odds ratio of annual center volume of neonatal cardiac operations for operative mortality reached its maximum of 1 at 60 operations per center per year. Above 60 operations per center per year, the odds ratio did not change and remained 1, which corresponds to a flat line in the graph visualizing operative mortality and annual volume of neonatal cardiac operations (Fig 2). The power of this finding is substantial owing to the size of the dataset that could only be derived from
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