Mortality as a measure of quality of care in infants with congenital cardiovascular malformations following surgery

• Published in: British medical bulletin 2014-09, Vol.111 (1), p.5-15
• Main Authors: Jensen, Hanna A, Brown, Katherine L, Pagel, Christina, Barron, David J, Franklin, Rodney C G
• Format: Article
• Language: English
• Subjects: Cardiac Surgical Procedures - mortality; Cardiac Surgical Procedures - standards; Heart Defects, Congenital - mortality; Heart Defects, Congenital - surgery; Humans; Infant; Quality of Health Care; Risk Adjustment - methods; United Kingdom - epidemiology
• ISSN: 0007-1420; 1471-8391
• DOI: 10.1093/bmb/ldu014

Mortality has traditionally been perceived as a straightforward measure of outcome and has been used to evaluate surgical performance. In the rapidly developing arena of paediatric cardiac surgery, the insightful analysis of mortality figures is challenging. This report discusses the issues involved when mortality is used as a marker for surgical outcome, referring to national and international audit and research data. Mortality is an important variable and should be transparently defined, reported and monitored. Definitions of mortality, assessments of risk and interpretations of reported statistics all have limitations that must be recognized. Traditional use of raw early mortality as a simplistic indicator of outcome and performance is evolving to include risk-adjusted mortality, longer-term survival, reinterventions and complications. As the vast majority of children undergoing cardiac surgery now survive beyond 30 days, the focus for measures of quality is shifting towards morbidity.