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Complex Neonatal Heart Surgeries Should Be Regionalized

High institution volume associated with lower mortality rates

FRIDAY, Jan. 4 (HealthDay News) -- Limiting complex neonatal cardiac surgeries, such as the Norwood procedure and the arterial switch operation, to high-volume centers would likely make the surgeries safer, according to an article published online Dec. 14 in Pediatric Cardiology.

Jennifer C. Hirsch, M.D., of the University of Michigan Medical Center in Ann Arbor, and colleagues examined data from the 2003 Kids' Inpatient Database to examine the impact of institutional volume on mortality rates for the Norwood procedure for hypoplastic left heart syndrome and the arterial switch operation (ASO) for transposition of the great arteries.

From the dataset, 547 children with transposition of the great arteries undergoing an ASO and 624 with patients with hypoplastic left heart syndrome undergoing a Norwood procedure were identified. The researchers uncovered an inverse association between institutional volume and in-hospital mortality for the Norwood procedure and the ASO.

"Based on our analysis of this hospital sample, referring all Norwood procedures to hospitals that perform 20 operations per year would reduce average mortality from 250 per 1,000 Norwoods (25 percent) to 167 per 1,000 (16.7 percent). Similarly, referring all ASOs to centers with 10 operations per year would reduce deaths from 54 per 1,000 (5.4 percent) ASOs to 32 per 1,000 (3.2 percent)," the authors write.

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