Long-term survival and center volume for functionally single-ventricle congenital heart disease in England and Wales

Brown, K. L., Huang, Q. ORCID: https://orcid.org/0000-0003-4456-2999, Hadjicosta, E., Seale, A. N., Tsang, V., Anderson, D., Barron, D., Bellsham-Revell, H., Pagel, C., Crowe, S., Espuny Pujol, F. ORCID: https://orcid.org/0000-0001-9085-7400, Franklin, R. and Ridout, D. (2023) Long-term survival and center volume for functionally single-ventricle congenital heart disease in England and Wales. The Journal of Thoracic and Cardiovascular Surgery, 166 (2). 306-316.e3. ISSN 0022-5223 doi: 10.1016/j.jtcvs.2022.11.018

Abstract/Summary

Objectives Long-term survival is an important metric for health care evaluation, especially in functionally single-ventricle (f-SV) congenital heart disease (CHD). This study's aim was to evaluate the relationship between center volume and long-term survival in f-SV CHD within the centralized health care service of England and Wales. Methods This was a retrospective cohort study of children born with f-SV CHD between 2000 and 2018, using the national CHD procedure registry, with survival ascertained in 2020. Results Of 56,039 patients, 3293 (5.9%) had f-SV CHD. Median age at first intervention was 7 days (interquartile range [IQR], 4, 27), and median follow-up time was 7.6 years (IQR, 1.0, 13.3). The largest diagnostic subcategories were hypoplastic left heart syndrome, 1276 (38.8%); tricuspid atresia, 440 (13.4%); and double-inlet left ventricle, 322 (9.8%). The survival rate at 1 year and 5 years was 76.8% (95% confidence interval [CI], 75.3%-78.2%) and 72.1% (95% CI, 70.6%-73.7%), respectively. The unadjusted hazard ratio for each 5 additional patients with f-SV starting treatment per center per year was 1.04 (95% CI, 1.02-1.06), P < .001. However, after adjustment for significant risk factors (diagnostic subcategory; antenatal diagnosis; younger age, low weight, acquired comorbidity, increased severity of illness at first procedure), the hazard ratio for f-SV center volume was 1.01 (95% CI, 0.99-1.04) P = .28. There was strong evidence that patients with more complex f-SV (hypoplastic left heart syndrome, Norwood pathway) were treated at centers with greater f-SV case volume (P < .001). Conclusions After adjustment for case mix, there was no evidence that f-SV center volume was linked to longer-term survival in the centralized health service provided by the 10 children's cardiac centers in England and Wales.

Item Type	Article
URI	https://reading-clone.eprints-hosting.org/id/eprint/118297
Identification Number/DOI	10.1016/j.jtcvs.2022.11.018
Refereed	Yes
Divisions	No Reading authors. Back catalogue items Science > School of Mathematical, Physical and Computational Sciences > Department of Computer Science
Publisher	Elsevier
Download/View statistics	View download statistics for this item