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Infant mortality after cardiac surgery is multifactorial, but can be related to center and surgeon case volume. One method to increase case volume is to consolidate or regionalize pediatric cardiac surgical care. We evaluated in-hospital and 5-year outcomes in three separate pediatric cardiac surgical programs before and after they formed one regional consortium. Infants (

The New York State Department of Health developed a Pediatric Cardiac Surgery Reporting System in 1991 that contains detailed information on demographics, diagnoses, procedures, comorbidities, complications, and discharge information for every pediatric cardiac surgery patient in the state. The Department and the Congenital Cardiac Services Subcommittee of the Department's Cardiac Advisory Committee have used data from this system to assess, assure, and improve quality of care and to generate public reports on an ongoing basis. Two reports (one covering 3years and the other covering 4years) have been published, and a third report, comprising the years 2006–2009, will be released shortly. These reports contain information on patient diagnoses, patient severity groups, and risk-adjusted in-hospital mortality rates for all hospitals that perform pediatric cardiac surgery. The goal of the DOH and the CAC is to improve the quality of cardiac care in NYS. Providing the hospitals and cardiac surgeons in NYS with data about their own outcomes for these procedures allows them to examine the quality of the care they provide and to identify areas that need improvement. These data are fed back to providers on an ongoing basis in addition to in the published reports. The overall results of this program of ongoing review show that significant progress is being made. The volume of surgeries and the number of hospitals where they are performed have both decreased dramatically in the years since NYS first began reporting risk-adjusted outcomes for pediatric cardiac surgery. In 1997, 16 hospitals performed 1749 pediatric cardiac surgeries. By 2009, there were only 10 hospitals performing 1304 surgeries. The average number of surgeries per hospital in 1997 was 109 compared to 139 in 2010. Many factors, including increased use of catheter-based therapies, may have contributed to the overall decline in the number of surgeries. The overall mortality rate for pediatric cardiac surgery dropped from 4.08% in 2002 to 2005 period to a mortality rate of 3.35% in 2006 to 2009 period with no major changes in overall patient risk, although part of this decrease may also be due to improvements in the field in general. A multivariable analysis demonstrated that a dedicated pediatric cardiac ICU proved to be a significant independent predictor of mortality. The methods for assessing patients' risk of in-hospital mortality have changed with each successive report, and this study describes the current method and the risk factors used in the method. The Department's other initiatives for improving quality, including consolidation of services, linking processes and structures of care to outcomes, and other regulatory actions, are also described.

Objective Although the arterial switch operation has been performed with very low mortality and morbidity in large pediatric cardiac surgical centers, we sought to determine if similar arterial switch results could be achieved in two medium-sized pediatric cardiac surgical centers that share one full-time surgeon who implements a comprehensive management protocol for both centers. Methods Patients with D-transposition of the great arteries undergoing arterial switch operations at two medium-sized pediatric cardiac surgery centers were evaluated for 30-day mortality and morbidity during three time periods: Period 1, before protocol was implemented at either center (Center 1: 11/1982–8/1995, Center 2: 3/1992–11/1999); Period 2, protocol implemented only at Center 1 (9/1995–11/1999); Period 3, protocol implemented at both centers with regional sharing of one surgeon (12/1999–1/2003). Results Ninety-six consecutive patients undergoing an arterial switch operation were reviewed. Mortality data were available for all cases. Mortality was 0% and significantly lower in Periods 2 and 3 versus Period 1 ( p p p Conclusions Outstanding surgical results for the arterial switch operation, similar to those in the largest pediatric cardiac surgical centers, are obtainable in two medium-sized pediatric cardiac surgery centers that share one full-time congenital heart surgeon. This model may be applicable in many other regions of the United States, where several medium-sized pediatric cardiac centers are within acceptable driving distance.