Quantification of Outcomes in Surgery for Congenital Heart Diseases in 2012-2015: a Four-Year Experience with the International Quality Improvement Collaborative Program

Background: The health care system is undergoing an increasing interest in crossing the quality chasm. Surgery for congenitalheart defects has improved in terms of outcomes and quality of life; however, the risk of mortality and infection requiresto be quantified. The goal of this study was to quantify the outcomes of surgery for congenital heart diseases following theInternational Quality Improvement Collaborative (IQIC) for Congenital Heart Disease program.Methods: This observational and interventional study was conducted at a tertiary children’s hospital in Cordoba, Argentina.Patients undergoing surgery for congenital heart defects between January 1, 2012, and December 31, 2015, were included.The following variables were quantified: sex, age, weight, risk-adjusted congenital heart surgery score, non-adjusted risk,standardized in-hospital mortality ratios and standardized infection ratio (observed rate/expected rate) with their corresponding95% confidence intervals. The results were compared with the IQIC for Congenital Heart Disease program standards(1.0=standardized rates, <1=improvement). The IQIC guidelines based on key drivers -safe perioperative practice, reductionof infections and team-based practice- were implemented as intervention for improvement. Results: A total of 373 surgical procedures for congenital heart defects were performed on 203 male patients and 170 femalepatients assigned to the following RACHS-1 categories: I: 28.4%, II: 44%, III: 24.4% and IV-VI 3.2%. Non-adjusted mortalityrate at 6 months was of 6%, 3%, 8%, 9%, 11%, 0%, 0% and 5%, respectively (standardized rates 4-6%). Standardized in-hospitalmortality ratios and their corresponding confidence intervals were 0.85 (0.23-2.18), 1.82 (0.79-3.59), 1.07 (0.39-2.34), and0.36 (0.04-1.29), respectively. Non-adjusted infection rate at 6 months was of 4%, 23%, 25%, 14%, 13%, 6%, 9% and 16%,respectively (standardized rates 5-7%).Standardized infection ratios and their corresponding confidence intervals were 1.89 (1.12-2.99), 1.87 (1.17-2.83), 2.0 (1.20-3.12), 1.22 (0.61-2.18), respectively.Conclusion: The implementation of the International Quality Improvement Collaborative for Congenital Heart Disease programwith the use of guidelines based on key drivers in a public tertiary hospital in Cordoba, Argentina, contributed to quantifyingand improving the outcomes. While mortality decreased, the rate of infections is still to be improved.