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Multicenter Study
. 2018 Feb;105(2):615-621.
doi: 10.1016/j.athoracsur.2017.06.027. Epub 2017 Oct 5.

Duration of Postoperative Mechanical Ventilation as a Quality Metric for Pediatric Cardiac Surgical Programs

Michael Gaies  1 , David K Werho  2 , Wenying Zhang  3 , Janet E Donohue  4 , Sarah Tabbutt  5 , Nancy S Ghanayem  6 , Mark A Scheurer  7 , John M Costello  8 , J William Gaynor  9 , Sara K Pasquali  10 , Justin B Dimick  11 , Mousumi Banerjee  12 , Steven M Schwartz  13
Affiliations
Multicenter Study

Duration of Postoperative Mechanical Ventilation as a Quality Metric for Pediatric Cardiac Surgical Programs

Michael Gaies et al. Ann Thorac Surg. 2018 Feb.

Abstract

Background: Few metrics exist to assess quality of care at pediatric cardiac surgical programs, limiting opportunities for benchmarking and quality improvement. Postoperative duration of mechanical ventilation (POMV) may be an important quality metric because of its association with complications and resource utilization. In this study we modelled case-mix-adjusted POMV duration and explored hospital performance across POMV metrics.

Methods: This study used the Pediatric Cardiac Critical Care Consortium clinical registry to analyze 4,739 hospitalizations from 15 hospitals (October 2013 to August 2015). All patients admitted to pediatric cardiac intensive care units after an index cardiac operation were included. We fitted a model to predict duration of POMV accounting for patient characteristics. Robust estimates of SEs were obtained using bootstrap resampling. We created performance metrics based on observed-to-expected (O/E) POMV to compare hospitals.

Results: Overall, 3,108 patients (65.6%) received POMV; the remainder were extubated intraoperatively. Our model was well calibrated across groups; neonatal age had the largest effect on predicted POMV. These comparisons suggested clinically and statistically important variation in POMV duration across centers with a threefold difference observed in O/E ratios (0.6 to 1.7). We identified 1 hospital with better-than-expected and 3 hospitals with worse-than-expected performance (p < 0.05) based on the O/E ratio.

Conclusions: We developed a novel case-mix-adjusted model to predict POMV duration after congenital heart operations. We report variation across hospitals on metrics of O/E duration of POMV that may be suitable for benchmarking quality of care. Identifying high-performing centers and practices that safely limit the duration of POMV could stimulate quality improvement efforts.

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Figures

Figure 1
Figure 1
plot of mean expected duration of postoperative mechanical ventilation (POMV) in equal rank ordered groups (red squares) vs. mean observed duration within group (black triangles).
Figure 2
Figure 2
observed-to-expected (O/E) ratio of duration of postoperative mechanical ventilation (POMV). Hospitals are rank ordered with A=lowest O/E and M=highest. Hospital A has statistically-significant less than expected duration of POMV, while hospitals K–M have significantly greater than expected POMV.
Figure 3
Figure 3
percentage of patients with expected postoperative mechanical ventilation (POMV) >12 hours who had observed POMV <6 hours (Success, black), and those with an expected duration of POMV <6 hours who had observed POMV >12 hours (Failure, red).
Figure 4
Figure 4
percentage of patients by hospital whose observed duration of postoperative mechanical ventilation (POMV) was <50% expected duration of POMV.
Figure 5
Figure 5
total days of postoperative mechanical ventilation (POMV) saved (black) or lost (red) at each center, per 100 hospitalizations. Hospitals are rank ordered with A=best performance (days saved) and M=worst performance (days lost). * denotes hospitals with statistically significant days saved/lost (p<0.05).
See this image and copyright information in PMC

References

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