Cardiac Surgery Risk Adjustment

Measures of hospital performance in congenital heart surgery are important for improving outcomes, public reporting and for parents making decisions about care of their children. However, it is not easy to assess performance in the field of congenital heart surgery. One reason for this is the significant differences in the types of heart defects treated at different hospitals. Some hospitals treat larger numbers of patients who are very young (babies), have very complex heart defects, and have additional medical problems; whereas other hospitals may tend to treat less complex patients. Recent studies have shown that patients who are born prematurely, are small at the time of surgery or who have genetic syndromes or other abnormalities often do poorly after congenital heart surgery. Therefore, it can be misleading to try to assess outcomes and compare hospitals without accounting for these factors (a method called “risk adjustment”).

To compare outcomes for a specific procedure between hospitals, it is necessary to have some idea of differences in the types of heart defects, characteristics of the patients treated and operations performed at each hospital. Simply comparing the risk of dying (mortality) after surgery without adjusting for these differences may give a misleading picture. A hospital which cares for low risk patients may have a very low death rate. Yet this does not mean that results would be similar results for more complicated patients.

Unfortunately, there is no standard way to adjust for these differences between hospitals. The results presented here for the Benchmark Procedures are not risk-adjusted. It is important to recognize that many factors may affect the risk of dying after surgery. When choosing a hospital for your child, it is important to discuss all health conditions with your pediatrician and cardiologist.

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