Assessment of mortality rates for congenital heart defects and surgeons' performance

Background. In the absence of reliable national data, we have collected res ults of all operations for congenital heart defects from five departments t o assess mortality rates and compare them among surgeons and departments. Methods. Data relating to all operations (2,718) carried out at the five ce nters during a period from April 1, 1997 through March 31, 1999. Clearly de fined criteria were agreed for the classification of patients into various subgroups. Results. The overall hospital mortality was 4.4% (95% confidence intervals 3.7%-5.3%). Mortality for open operations was 12.6% in neonates, 5.1% in in fants, and 3.5% in children. Mortality rates were 1.1% for coarctation, 0.4 % ventricular septal defect, 4.1% atrioventricular septal defect, 2.9% Fall ot, 0.9% switch, and 15.6% truncus arteriosus. Although individual surgeons ' mortality rates ranged from 1.8% to 7.5%, none of the 12 surgeons' data w ere above 95% confidence intervals. For individual surgeons, the change in mortality rates between the 2 years ranged between -3.3% and +3.8%. Conclusions. With 2 years' data available, estimates of mortality rates are more precise as reflected by tighter confidence intervals. There were rela tively small data sets for individual hospitals and surgeons, which made st atistical evaluation difficult. For setting standards, data from more depar tments for a longer period will be required. Statistical methods alone cann ot be used as a sole arbiter of what is considered acceptable performance. (C) 2001 by The Society of Thoracic Surgeons.