Background: Surveillance of risk-adjusted pediatric cardiac surgery outcomes has moved beyond mortality to complications. We report a novel dashboard that provides for real-time graphic presentation of risk-adjusted complications to ensure that program performance is maintained and to identify areas for improvement.
Methods and Materials: This was a single center study, performed at a medium volume program after IRB approval. Data were collected on consecutive patients over a one-year period (Oct 4, 2016- Oct 3, 2017) coincident with the restart of a pediatric cardiac surgical program. Mortality data are plotted using Variable Life Adjusted Display (VLAD). Complications are collected for each patient prospectively using STS standard definitions and CUSUM and O-E plots generated. Complication burden (accounting for both frequency and severity of complications) was calculated for each STAT category and compared to historic data.
Results: Mortality rate for the cohort was 3.6% (6/164, Fig 1, panel A). In 94 patients, there were no complications (57.3%). Thirty-five patients had 1 complication and 35 had <2 complications. Complications resulting in mortality (failure-to-rescue rate) is 8.7%. Most common complications were pulmonary (40, 23.4%) arrhythmia (27, 15.8%), and neurologic (28, 16.4%). High risk complications occurred infrequently including acute renal failure (n=14), bleeding requiring reoperation (n=4), unexpected cardiac arrest (n=3), low cardiac output (n=11), mechanical circulatory support (n=7), neurologic deficit (n=9), and sepsis (n=1) (Fig 1, panel B). Four outlier patients account for spikes in the O-E CUSUM plot (Fig 1, panel C). Complication severity and frequency escalate with increasing STAT category (Fig 1, panel D).
Conclusion: A continuously updated dashboard permits real-time adverse outcome reporting, potentially allowing earliest identification of areas of concern or focus. Proof of the value of this approach will require replication in additional centers of various size.