Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual
Volume 13, Issue 1 , Pages 79-83 , 2010

Chance, Bias, and Confounding: Threats to Valid Measurement of Quality in the Context of Pediatric Cardiac Surgery

  • Karl F. Welke, MD, MS

      Affiliations

    • Surgeon, Mary Bridge/Swedish Pediatric Cardiothoracic Surgery Program, Mary Bridge Children's Hospital and Health Center, Multicare Health System
    • Corresponding Author InformationAddress correspondence to Karl F. Welke, MD, Mary Bridge/Swedish Pediatric Cardiothoracic Surgery Program, Mary Bridge Children's Health Center, 311 South L St, PO Box 5299, Tacoma, WA 98415
    • ,
  • Brian S. Diggs, PhD

      Affiliations

    • Statistician, Department of Surgery, Oregon Health and Science University
    • ,
  • Tara Karamlou, MD, MSc

      Affiliations

    • Thoracic Surgery Resident, Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health & Science University

References 

  1. The Society of Thoracic Surgeons Congenital Heart Surgery Data Summary July 2005 - June 2009 Procedures All Patients (Fall 2009 Harvest). http://www.sts.org/documents/pdf/ndb/STSCONG-AllPatientsSummary_Fall2009.pdf(Accessed Feb 16, 2010)
  2. Welke KF, Karamlou T, Ungerleider RM, et al. Mortality is not a valid indicator of quality differences between pediatric cardiac surgery programs. Ann Thorac Surg. 2010;89:139–144
  3. Jenkins KJ, Gauvreau K, Newburger JW, et al. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg. 2002;123:110–118
  4. Cronk CE, Malloy ME, Pelech AN, et al. Completeness of state administrative databases for surveillance of congenital heart disease. Birth Defects Res Clin Mol Tetratol. 2003;67:597–603
  5. Frohnert BK, Lussky RC, Alms MA. Validity of hospital discharge data for identifying infants with cardiac defects. J Perinatol. 2005;25:727–742
  6. Jenkins KJ, Newburger JW, Locke JE, et al. In-hospital mortality for surgical repair of congenital heart defects: preliminary observations of variation by hospital caseload. Pediatrics. 1995;95:323–330
  7. Hannan EL, Racz M, Kavey RE, et al. Pediatric cardiac surgery: the effect of hospital and surgeon volume on in-hospital mortality. Pediatrics. 1998;101:963–969
  8. Sollano JA, Gelijns AC, Moskowitz AJ, et al. Volume-outcome relationships in cardiovascular operations: New York State, 1990-1995. J Thorac Cardiovasc Surg. 1999;117:419–428
  9. Chang RK, Klitzner TS. Can regionalization decrease the number of deaths for children who undergo cardiac surgery? (A theoretical analysis). Pediatrics. 2002;109:173–181
  10. Bazzani LG, Marcin J. Case volume and mortality in pediatric cardiac surgery patients in California, 1998-2003. Circulation. 2007;115:2652–2659
  11. Welke KF, Diggs BS, Karamlou T, et al. The relationship between hospital surgical case volumes and mortality rates in pediatric cardiac surgery: a national sample 1988-2005. Ann Thorac Surg. 2008;86:889–896
  12. Welke KF, O'Brien SM, Peterson ED, et al. The complex relationship between pediatric cardiac surgical case volumes and mortality rates in a national clinical database. J Thorac Cardiovasc Surg. 2009;137:1133–1140
  13. Lacour-Gayet F, Clark D, Jacobs J, et al. The Aristotle score: a complexity-adjusted method to evaluate surgical results. Eur J Cardiothorac Surg. 2004;25:911–924
  14. Welke KF, Diggs BS, Karamlou T, et al. Comparison of pediatric cardiac surgical mortality rates from national administrative date to contemporary clinical standards. Ann Thorac Surg. 2009;87:216–223
  15. O'Connor GT, Plume SK, Olmstead EM, et al. A regional intervention to improve the hospital mortality associated with coronary artery bypass graft surgery. JAMA. 1996;275:841–846
  16. Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). 1988-2005. Rockville, MD: Agency for Healthcare Research and Quality www.hcup-us.ahrq.gov/nisoverview.jsp(Accessed Sept 29, 2009)

PII: S1092-9126(10)00004-9

doi: 10.1053/j.pcsu.2010.01.003

Seminars in Thoracic and Cardiovascular Surgery: Pediatric Cardiac Surgery Annual
Volume 13, Issue 1 , Pages 79-83 , 2010

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