Miami Children's Hospital

MCH Cardiac Program Real Time Outcomes in Congenital Heart Surgery

At Miami Children’s Hospital our programmatic goal is to improve the care of patients with congenital heart disease, minimizing trauma to patients and families over the course of their lifetimes. We strive to be the most innovative and transparent congenital heart program in the world. To achieve this we measure our performance continuously and report our results publicly in real time. This practice enhances our ability to identify and correct clinical problems and provides our colleagues, patients and families with accurate and useful outcomes data for decision making.

This Website only gives a snapshot of the available information. The data you see below is generated dynamically by our cardiac program database, in real time, every time you load this page. It is the same data we submit to the Society of Thoracic Surgeon’s Congenital Heart Surgery Database (STS) and that we submit to the Florida Children’s Medical Service Cardiac Subcommittee.

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Performance Analysis By Age

All fields below are dynamic - updated in real-time from the cardiac program electronic medical record, except blue fields which contain fixed values from the medical literature.

Last Procedure Recorded on 10/21/2014                     Currently Selected Date Range: 1/1/2001 - 10/21/2014

Category
Number Of Patients
Number Of Procedures
Number Of CPB
Number Of Non CPB
Number Of Mortalities
Procedure Mortality
STS Last 1 Year Mortality (1/2013-12/2013)
STS Last 4 Year Mortality (1/2010-12/2013)
Neonates (0-30 Days)854854672182718.3%9.0%9.8%
Infants (31 Days - 1 Year)115111961053143151.3%2.7%3.1%
Children (>1 Year - <18 Years)116312661138128100.8%1.1%1.2%
Adults (18 Years and above)1401551045131.9%2.0%2.0%
Totals:330834712967504992.9% 3.2% 3.5%

Performance Analysis By Procedure and Complexity

All fields below are dynamic - updated in real-time from the cardiac program electronic medical record, except blue fields which contain fixed values from the medical literature. References provided below.

Last Procedure Recorded on 10/21/2014                     Currently Selected Date Range: 1/1/2001 - 10/21/2014

Category
Number Of Patients
Median Age In Days
Number Of Mortalities
Percent Mortality
STS Last 4 Year Mortality (1/2010-12/2013)
Median Length of PostOp Stay (Days)
STS Median PostOp Stay (Days)
VSD Repair28015400.0%0.7%58
TOF Repair18510510.5%1.0%610
Arterial Switch105611.0%2.6%916
Complete AV Canal Repair11313610.9%3.0%716
Arterial Switch + VSD Repair36812.8%5.0%916
Fontan242145341.7%1.6%1013
Truncus Repair321413.1%8.9%1528
Norwood14861610.8%15.7%1538

Performance Comparison by The Society of Thoracic Surgeons - European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Categories (STAT Mortality Categories)

All fields below are dynamic - updated in real-time from the cardiac program electronic medical record, except blue fields which contain fixed values from the medical literature.

Last Procedure Recorded on10/21/2014                         Currently Selected Date Range: 1/1/2001 - 10/21/2014

STAT Category
Number Of Patients
Median Length Of PostOp Stay
Median Age In Days
Number Of Mortalities
Percent Mortality
STS Last 1 Year Mortality (1/2013-12/2013)
STS Last 4 Year Mortality (1/2010-12/2013)
11046490540.4%0.6%0.7%
29997281131.3%1.6%1.9%
337399182.1%2.6%3.1%
46391212467.2%7.4%7.6%
51931562311.9%15.2%16.9%

STAT category is the STS Risk Assessment Scale. Higher numbers are higher risk.

The tables above follow STS definitions. References to the STS methodology and definitions may be found here. Operative mortality is defined as in hospital or 30 day mortality. Only operations with an STS STAT risk score of 1 or greater are included in the analysis. STAT is a risk stratification method used by the STS and is based on operation type only, with a higher STAT score indicating an operation with a greater risk of mortality.. Minor operations are excluded from the data below. One year STS mortality is typically for the 12 months ending about 6 months before the search. STS four year mortality is the aggregate mortality of the previous 4 years again ending about six months before the search. Miami Children’s data is accurate to the day of the search.


Performance Sparkline

Each tick mark in the graphic below represents a cardiac surgical procedure. Surviving patients are indicated by upward tick marks and mortalities are indicated by the downward tick marks in the sequence. Every 250 cases the graphic wraps to the next line for comparison. The sparkline is read like a book from left to right and from top to bottom.

Currently Selected Date Range: 1/1/2001 - 10/21/2014

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Outcomes Data and Choosing a Cardiac Program

In deciding where your child or other family member should be cared for it is important to ask questions. These are some of the questions we encourage parents and patients to ask of us at Miami Children’s Hospital:

  • How many patients with similar diagnosis are seen in the center in a year, the past four years, and the past ten years?
  • How many open heart operations does the program do a year? How many of the type of operation that your child requires are done a year, the past four years, and the past ten years?
  • Where does the volume of the program stand in relation to the volume of other programs in the area? • What are the outcomes? Are they publicly available?
  • What are the outcomes in relation to the publicly available outcomes of other centers in the area, in the region, in the country?
  • It is completely appropriate to insist to see the relevant Society of Thoracic Surgeons Congenital Heart Surgery Database tables so you can compare actual outcomes rather than vague approximations. This is explicitly allowed by the STS. Ask to see the risk adjusted outcomes as well as they are key indicator of programmatic results.
  • There are other outcome measures that are relevant in some cases. What is the rate of complications like renal failure, tracheostomy, gastrostomy, and pacemaker placement?
  • Ask about the resources available.

    Are there two or more surgeons on site? What is their training and experience?

    What is the experience and training of the other physicians on the cardiac team: echocardiographers, intensivists, interventional cardiologists, electrophysiologists?

    What is the programmatic experience? How stable is program? Are the results being reported the results for the people currently in the program?

    Is there a dedicated Cardiac Intensive Care Unit that cares only for cardiac patients with in house physician coverage 24/7? Are the physicians dedicated to caring only for patients with congenital heart disease?

    Are there dedicated pediatric echocardiographers who routinely perform intraoperative transesophageal echocardiography?

    Is there a dedicated pediatric cardiac MRI program?

    Is there a dedicated pediatric cardiac catheterization laboratory that specializes in congenital heart disease? Or are children with congenital heart disease catherized in an adult laboratory?

    Is there a dedicated cardiac anesthesia team?

    Is there a dedicated perfusion (heart lung machine) team that specializes in congenital heart disease?

    Is there a High Risk Clinic for at risk patients after neonatal palliative surgery?

    Are there dedicated contact people available before, during and after surgery? Ask to meet those contact persons.

    Meet the surgeons. Ask questions. Ask for a tour.

    Expect and demand the highest level of care for your child or family member.

Analyzing Outcomes Data

In evaluating programmatic results it is very important to recognize that every child and every patient is different. Outcomes data is an aggregation of patients: we care for individual patients with differing risk factors, differing anatomy, and differing history. In addition, in comparing programmatic results, it is important to recognize that different programs may have different philosophies in caring for patients and that these philosophical differences do not imply that one program is “better” than another. What is best for your child or family member is the question.

The outcomes data above is an aggregation of patients and the risk stratification presented is based on type of operation only. More complex risk stratification methods are also used by the Society of Thoracic Surgeon’s Database. Metrics that include birth weight, genetic anomalies and severity of illness are also collected by the STS and analyzed. These metrics are then presented as Observed (actual) Mortality versus Expected (predicted) Mortality based on severity. We look forward to sharing this data with you in person.

We are hopeful that you find the information useful. Should you require more specific outcomes data or more information regarding our program, please do not hesitate to contact us at 305-663-8401.

For reference information please click here and here

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