Hospital variation in post-operative cardiac extracorporeal membrane oxygenation use and relationship to post-operative mortality

Marissa A Brunetti; J William Gaynor; Wenying Zhang; Mousumi Banerjee; Yuliya A Domnina; Michael Gaies

doi:10.1017/S1047951124026568

Hospital variation in post-operative cardiac extracorporeal membrane oxygenation use and relationship to post-operative mortality

Cardiol Young. 2024 Oct 4:1-8. doi: 10.1017/S1047951124026568. Online ahead of print.

Authors

Marissa A Brunetti¹, J William Gaynor², Wenying Zhang³, Mousumi Banerjee⁴, Yuliya A Domnina⁵, Michael Gaies⁶

Affiliations

¹ Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia & Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
² Department of Surgery, The Cardiac Center, The Children's Hospital of Philadelphia & Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
³ Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI, USA.
⁴ Department of Biostatistics, School of Public Health & Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
⁵ Division of Cardiac Critical Care Medicine, George Washington University School of Medicine and Children's National Hospital, Washington, DC, USA.
⁶ Department of Pediatrics, Cincinnati Children's Hospital Medical Center Heart Institute, University of Cincinnati College of Medicine, Cincinnati, OH, USA.

PMID: 39364539
DOI: 10.1017/S1047951124026568

Abstract

Objective: It is unclear how extracorporeal membrane oxygenation use varies across paediatric cardiac surgical programmes and how it relates to post-operative mortality. We aimed to determine hospital-level variation in post-operative extracorporeal membrane oxygenation use and its association with case-mix adjusted mortality.

Methods: Retrospective analysis of 37 hospitals contributing to the Pediatric Cardiac Critical Care Consortium clinical registry from 1 August 2014 to 31 December 2019. Hospitalisations including cardiothoracic surgery and post-operative admission to paediatric cardiac ICUs were included. Two-level multivariable logistic regression with hospital random effect was used to determine case-mix adjusted post-operative extracorporeal membrane oxygenation use rates and in-hospital mortality. Hospitals were grouped into extracorporeal membrane oxygenation use tertiles, and mortality was compared across tertiles.

Results: There were 43,640 eligible surgical hospitalisations; 1397 (3.2%) included at least one post-operative extracorporeal membrane oxygenation run. Case-mix adjusted extracorporeal membrane oxygenation rates varied more than sevenfold (0.9-6.9%) across hospitals, and adjusted mortality varied 10-fold (0-5.5%). Extracorporeal membrane oxygenation rates were 2.0%, 3.5%, and 5.2%, respectively, for low, middle, and high extracorporeal membrane oxygenation use tertiles (P < 0.0001), and mortality rates were 1.9%, 3.0%, and 3.1% (p < 0.0001), respectively. High extracorporeal membrane oxygenation use hospitals were more likely to initiate extracorporeal membrane oxygenation support intraoperatively (1.6% vs. 0.6% low and 1.1% middle, p < 0.0001). Extracorporeal membrane oxygenation indications were similar across hospital tertiles. When extracorporeal cardiopulmonary resuscitation was excluded, variation in extracorporeal membrane oxygenation use rates persisted (1.5%, 2.6%, 3.8%, p < 0.001).

Conclusions: There is hospital variation in adjusted post-operative extracorporeal membrane oxygenation use after paediatric cardiac surgery and a significant association with adjusted post-operative mortality. These findings suggest that post-operative extracorporeal membrane oxygenation use could be a complementary quality metric to mortality to assess performance of cardiac surgical programmes.

Keywords: CHDs; ICUs; cardiac surgical procedure; extracorporeal membrane oxygenation; heart disease; perioperative care.