Showing papers by "James H. Moller published in 2013"
TL;DR: In conclusion, center-specific variation exists but is only partially explained by operative volume, whereas regionalization or other quality improvement strategies appear to be warranted for moderate- and high-risk operations.
Abstract: Mortality after pediatric cardiac surgery varies among centers. Previous research suggests that surgical volume is an important predictor of this variation. This report characterizes the relative contribution of patient factors, center surgical volume, and a volume-independent center effect on early postoperative mortality in a retrospective cohort study of North American centers in the Pediatric Cardiac Care Consortium (up to 500 cases/center/year). From 1982 to 2007, 49 centers reported 109,475 operations, 85,023 of which were analyzed using hierarchical multivariate logistic regression analysis. Patient characteristics varied significantly among the centers. The adjusted odds ratio (OR) for mortality decreased more than 10-fold during the study period (1982 vs. 2007: OR, 12.27, 95 % confidence interval [CI], 8.52–17.66; p < 0.0001). Surgical volume was associated inversely with odds of death (additional 100 cases/year: OR, 0.84; 95 % CI, 0.78–0.90; p < 0.0001). In the analysis of interactions, this effect was fairly consistent across age groups, risk categories (except the lowest), and time periods. However, a volume-independent center effect contributed substantially more to the risk model than did the volume. The Risk Adjusted Classification for Congenital Heart Surgery, version 1 (RACHS-1) risk category remains the strongest predictor of postoperative mortality through the 25-year study period. In conclusion, center-specific variation exists but is only partially explained by operative volume. Low-risk operations are safely performed at centers in all volume categories, whereas regionalization or other quality improvement strategies appear to be warranted for moderate- and high-risk operations. Potentially preventable mortality occurs at centers in all volume categories studied, so referral or regionalization strategies must target centers by observed outcomes rather than assume that volume predicts quality.
52 citations
TL;DR: Considering the variety of tumors, their varied location in cardiac structures, the patient ages, and the infrequent occurrence in an individual surgeon’s experience, the operative mortality was low.
Abstract: Cardiac tumors in children are rare, and patient series are limited in size. We report 120 children who underwent surgery to treat a cardiac tumor; the tumor type was known in 108 instances. The patients represented <0.1 % of 130,000 cardiac surgeries performed in children from a multi-institutional data base. The most common tumors and the number of patients were rhabdomyoma (n = 42), myxoma (n = 28), and fibromas (n = 10). The remaining 18 tumors of various types occurred in smaller numbers of patients. Nine patients (7 %) died after surgery. The mean age of death was 14 days, and death was most frequent in patients with fibromas (n = 4). Considering the variety of tumors, their varied location in cardiac structures, the patient ages, and the infrequent occurrence in an individual surgeon’s experience, the operative mortality was low.
35 citations
TL;DR: From 1952 to 1963, 1,000 consecutive children with congenital heart disease were evaluated by 1 of us, and this experience should be helpful to physicians caring for adults with congenitals heart disease and provide an optimistic outlook for the patients with less complex conditions.
Abstract: From 1952 to 1963, 1,000 consecutive children with congenital heart disease were evaluated by 1 of us (R.C.A.). Current information for 994 patients with 36,086 patient-years is available. Of these, 362 have died, 130 as adults, of whom 67 died from a cardiac cause. Of the remaining 638 patients, 632 were living, and 6 were lost to follow-up. The survival curves for ventricular septal defect, atrial septal defect, patent ductus arteriosus, and pulmonary stenosis paralleled the normal curve. Cyanotic patients had a markedly reduced curve, with 19% alive at 50 years. Most patients were New York Heart Association class I, with only 3 in class IV, each from noncardiac causes. In conclusion, this experience should be helpful to physicians caring for adults with congenital heart disease and provide an optimistic outlook for the patients with less complex conditions.
15 citations