Surgical Quality Predicts Length of Stay in Patients with Congenital Heart Disease

Eric A. Johnson, M. Mujeeb Zubair, Laurie R. Armsby, Grant H. Burch, Milon K. Good, Michael R. Lasarev, A. Roger Hohimer, Ashok Muralidaran, Stephen M. Langley

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Historically, the primary marker of quality for congenital cardiac surgery has been postoperative mortality. The purpose of this study was to determine whether additional markers (10 surgical metrics) independently predict length of stay (LOS), thereby providing specific targets for quality improvement. Ten metrics (unplanned ECMO, unplanned cardiac catheterization, revision of primary repair, delayed closure, mediastinitis, reexploration for bleeding, complete heart block, vocal cord paralysis, diaphragm paralysis, and change in preoperative diagnosis) were defined in 2008 and subsequently collected from 1024 consecutive index congenital cardiac cases, yielding 990 cases. Four patient characteristics and 22 case characteristics were used for risk adjustment. Univariate and multivariable analyses were used to determine independent associations between each metric and postoperative LOS. Increased LOS was independently associated with revision of the primary repair (p = 0.014), postoperative complete heart block requiring a permanent pacemaker (p = 0.001), diaphragm paralysis requiring plication (p < 0.001), and unplanned postoperative cardiac catheterization (p < 0.001). Compared with patients without each metric, LOS was 1.6 (95 % CI 1.1–2.2, p = 0.014), 1.7 (95 % CI 1.2–2.3, p = 0.001), 1.8 (95 % CI 1.4–2.3, p < 0.001), and 2.0 (95 % CI 1.7–2.4, p < 0.001) times as long, respectively. These effects equated to an additional 4.5–7.8 days in hospital, depending on the metric. The other 6 metrics were not independently associated with increased LOS. The quality of surgery during repair of congenital heart disease affects outcomes. Reducing the incidence of these 4 specific surgical metrics may significantly decrease LOS in this population.

Original languageEnglish (US)
Pages (from-to)593-600
Number of pages8
JournalPediatric Cardiology
Issue number3
StatePublished - Mar 1 2016


  • Congenital heart
  • Length of stay
  • Metrics
  • Quality improvement
  • Surgery

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine


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