Author: Nicholas Houska, DO - University of Colorado, Children’s Hospital Colorado
A 2023 consensus statement endorsed by sixteen professional societies, including the Congenital Cardiac Anesthesia Society, recommends a two-tier classification of pediatric heart surgery programs. To optimize high-complexity pediatric heart surgery, what is the minimum number of congenital heart surgeons recommended for Comprehensive Care Centers?
EXPLANATION
The Congenital Heart Surgeon’s Society has recently developed consensus recommendations for centers performing pediatric cardiac surgery in the United States, which were endorsed by fifteen other societies representing healthcare professionals caring for children and adults with congenital heart disease. The current system of healthcare delivery for pediatric heart surgery in the United States consists of a multitude of centers with wide variability in location, volume, and case complexity. Pediatric cardiac surgical outcomes differ widely after low and high complexity procedures and when compared across different care centers. This is likely related to wide variability in staffing models, program structure, resources, and perioperative care practices and processes between centers. Numerous studies have shown an association between surgical volume and outcomes, with low volume centers having higher mortality. Furthermore, studies have shown that both high performing and low performing centers have the potential for improvement in outcomes. National efforts have been made to reduce variability and improve outcomes, including public reporting, quality improvement networks, disseminating best practices, and developing consensus-based standards and guidelines for care.
The consensus statement settled on two tiers of recommendations. The first tier is termed “Essential” and consists of recommendations for fundamental components to promote high-quality care for any pediatric heart surgery program. The second tier is termed “Comprehensive” and consists of recommendations to optimize high-complexity pediatric heart surgery. Per the consensus statement, at least three surgeons are recommended in a Comprehensive Care Center to optimize high complexity pediatric cardiac surgery. The consensus statement also highlights that these are recommendations, and that individual center variability may be deemed necessary as appropriate.
REFERENCES
Backer CL, Overman DM, Dearani JA, et al. Recommendations for centers performing pediatric heart surgery in the United States. J Thorac Cardiovasc Surg . 2023. https://doi.org/10.1016/j.jtcvs.2023.09.001 Published online September 2023
