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Volume and Outcomes Data
Johns Hopkins All Children’s Heart Institute

The Johns Hopkins All Children's Heart Institute believes the public has a right to know the quality of surgical outcomes and considers public reporting an ethical responsibility of the specialty. The data about Volumes and Outcomes reported on our web site is reflective of the collaboration of the entire multidisciplinary team at Johns Hopkins All Children's Heart Institute, including cardiac surgery, cardiology, cardiac anesthesia, critical care, nursing, and perfusion.

Florida is the fourth largest state in the United States of America.  The Johns Hopkins All Children's Heart Surgery Program is the one of largest pediatric and congenital cardiac programs in the nation.

The Johns Hopkins All Children's Heart Institute publicly reports our Volume Data and Outcome Data to aid patients and their families in making informed decisions about healthcare.  We use Quality Measures developed and endorsed by The Society of Thoracic Surgeons (STS) and The Congenital Heart Surgeons’ Society (CHSS). View the References for Data about Volume and Outcome.

Volume Data

At Johns Hopkins All Children's Heart Institute, we believe that outcomes after cardiac surgery correlate with the experience of the program and the annual surgical volume of the program.  As one of the largest pediatric cardiac surgery programs in the nation, we are happy to share our volume and outcome data.

Medical literature supports the relationship between programmatic volume and outcome. View the References for Data about Volume and Outcome. In fact, an analysis of the STS Congenital Heart Surgery Database concludes that “There was an inverse association between pediatric cardiac surgical volume and mortality that became increasingly important as case complexity increased. Although volume was not associated with mortality for low-complexity cases, lower-volume programs underperformed larger programs as case complexity increased.”

Created in 2012, the Johns Hopkins Children’s Heart Surgery Program includes a team of pediatric cardiovascular surgeons at All Children’s Hospital in St. Petersburg and Florida Hospital for Children in Orlando along with colleagues in Baltimore.  The combined strengths of this comprehensive team facilitate collaboration in the domains of patient care, research and education.  Johns Hopkins Children’s Heart Surgery is home to a combined total of more than 1,000 pediatric and congenital cardiothoracic operations per year at three hospitals, making our program one of the largest in the nation.  The surgeons working together provides new opportunities for excellence in clinical care as well as collaborative research in cardiac surgery in order to develop innovative approaches in treating congenital heart disease.

This table documents the surgical volume of our program every year since 2000 and documents that our program is one of the largest pediatric cardiac programs in Florida.

All Children's Hospital Cardiac Volume and Outcomes Data Table 1:  Annual Programmatic Volume

In the table below, we provide annual volume data for 6 categories:

  1. ACH Open is defined as all open heart case surgery operations done on cardiopulmonary bypass using the cardiopulmonary bypass machine that were performed by our cardiac surgical team at All Children’s Hospital.
  2. Total Open is defined as all open heart case surgery operations done on cardiopulmonary bypass using the cardiopulmonary bypass machine that were performed by our cardiac surgical team.
  3. ACH Closed is defined as all operations that are not open heart case surgery operations that were performed by our cardiac surgical team at All Children’s Hospital.
  4. Total Closed is defined as all operations that are not open heart case surgery operations that were performed by our cardiac surgical team.
  5. ACH All Operations is defined as all operations that were performed by our cardiac surgical team at All Children’s Hospital.
  6. All Operations is defined as all operations that were performed by our cardiac surgical team.
  ACH Open Total Open ACH Closed Total Closed ACH All Operations All Operations
2000 184 429 184 254 368 683
2001 175 398 207 308 382 706
2002 182 407 185 408 367 815
2003 165 404 186 438 351 842
2004 168 340 245 422 413 762
2005 211 416 244 382 455 798
2006 178 371 228 391 406 762
2007 168 355 255 408 423 763
2008 177 333 209 331 386 664
2009 168 339 202 307 370 646
2010 187 348 208 336 395 684
2011 203 315 222 327 425 642
2012 185 324 269 366 454 690
2013 202 363 292 388 494 751

Outcome Data

All Children’s Hospital publicly reports our outcomes using the audited and risk adjusted data of the STS Congenital Heart Surgery Database. 

The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) is the largest database in the world of patients who have undergone congenital and pediatric cardiac surgical operations.  STS-CHSD is a voluntary registry, which contains preoperative, operative and outcomes data for all patients undergoing congenital and pediatric cardiovascular operations at participating centers.  As of January 2014, the STS-CHSD contains data on more than 292,000 surgeries conducted since 2000 at 120 hospitals in North America, representing greater than 90% of all US centers performing congenital heart surgery and greater than 90% of all pediatric and congenital cardiac operations in the USA.

We share two types of data directly from our latest STS Congenital Heart Surgery Database Feedback Report:

  1. Complexity Stratified Operations
  2. Benchmark Operations

Complexity Stratified Operations

Complexity stratification is a method of analysis in which the data are divided into relatively homogeneous groups (called strata). 
The Society of Thoracic Surgeons (STS) - European Association for Cardio-Thoracic Surgery (EACTS) Congenital Heart Surgery Mortality Categories (STAT Mortality Categories) were introduced into the STS Congenital Heart Surgery Database Feedback Report in 2010.  The STAT Mortality Categories are an empirically derived methodology of complexity stratification based on statistical estimation of the risk of mortality from an analysis of objective data from the STS Congenital Heart Surgery Database and the EACTS Congenital Heart Surgery Database.  STAT Mortality Score and Categories were developed based on analysis of 77,294 operations entered in the STS Congenital Heart Surgery Databases and the EACTS Congenital Heart Surgery Database.  Operations were sorted by increasing risk and grouped into 5 categories that were designed to minimize within-category variation and maximize between-category variation

This graph and table documents the outcomes of pediatric and congenital cardiac surgery at All Children’s Hospital in comparison to aggregate data from STS using the STAT categories.

All Children's Hospital Cardiac Volume and Outcomes Data Table 2:  Complexity Stratified Operations

  All Children's Hospital Society of Thoracic Surgeons Aggregate Data
  Total Operations Operative Mortality Percent Operative Mortality with 95% Confidence Interval Total Operations Operative Mortality Percent Operative Mortality with 95% Confidence Interval
ALL Cardiac Operations 893 25 2.8 (1.8 , 4.1) 84,112 2,891 3.4 (3.3 , 3.6)
STAT Category 1 264 1 0.4 (0.0 , 2.1) 26,766 191 0.7 (0.6 , 0.8)
STAT Category 2 335 2 0.6 (0.1 , 2.1) 26,467 469 1.8 (1.6 , 1.9)
 STAT Category 3 67 1 1.5 (0.0 , 8.0) 8,887 283 3.2 (2.8 , 3.6)
STAT Category 4 168 12 7.1 (3.7 , 12.1) 15,632 1,155 7.4 (7.0 , 7.8)
STAT Category 5 45 9 20.0 (9.6 , 34.6) 3,638 610 16.8 (15.6 , 18.0)

Benchmark Operations

The STS Congenital Heart Surgery Database has published outcomes of benchmark operations. View the References for Data about Volume and Outcome.

Table 3 below is titled:

All Children's Hospital Cardiac Volume and Outcomes Data Table 3:  Benchmark Operations

This table documents the outcomes of pediatric and congenital cardiac surgery at All Children’s Hospital in comparison to aggregate data from STS for 26 benchmark operations.

All Children's Hospital Cardiac Volume and Outcomes Data Table 3:  Benchmark Operations

 

  All Children's Hospital Total Operations All Children's Hospital Operative Mortality All Children's Hospital Percent Operative Mortality Society of Thoracic Surgeons Percent Operative Mortality
ASD repair, Patch 20 0 0.0% 0.2%
VSD repair, Patch 79 0 0.0% 0.7%
AVC (AVSD) repair, Partial (Incomplete) (PAVSD) 18 0 0.0% 0.7%
AVC (AVSD) repair, Complete (CAVSD) 33 1 3.1% 2.7%
TOF repair, No ventriculotomy 4 0 0.0% 0.7%
TOF repair, Ventriculotomy, Nontransanular patch 20 0 0.0% 0.5%
TOF repair, Ventriculotomy, Transanular patch 29 0 0.0% 1.6%
DORV, Intraventricular tunnel repair 10 0 0.0% 4.3%
Conduit reoperation 22 0 0.0% 0.7%
Valvuloplasty, Aortic 21 0 0.0% 1.3%
Aortic stenosis, Subvalvar, Repair 16 0 0.0% 0.2%
Arterial switch operation (ASO) 16 0 0.0% 2.8%
Arterial switch operation (ASO) and VSD repair 14 0 0.0% 5.8%
Arterial switch procedure and VSD repair + Aortic arch repair 3 0 0.0% 11.7%
Coarctation repair, End to end 7 0 0.0% 1.4%
Coarctation repair, End to end, Extended 26 0 0.0% 1.2%
Aortic arch repair 20 0 0.0% 4.2%
Shunt, Systemic to pulmonary, Modified Blalock-Taussig Shunt (MBTS) 27 1 3.7% 6.9%
Shunt, Systemic to pulmonary, Central (from aorta or to main pulmonary artery) 6 0 0.0% 6.9%
Bidirectional cavopulmonary anastomosis (BDCPA) (bidirectional Glenn) 34 2 5.9% 1.3%
Bilateral bidirectional cavopulmonary anastomosis (BBDCPA) (bilateral bidirectional Glenn) 7 0 0.0% 3.0%
Superior Cavopulmonary anastomosis(es) + PA reconstruction 18 0 0.0% 2.5%
Valvuloplasty, Mitral 23 0 0.0% 1.7%
Fontan, TCPC, External conduit, Fenestrated 46 0 0.0% 1.8%
Truncus arteriosus repair 4 0.0%  8.3% 
Norwood procedure 39 8 20.5% 16.0%
Norwood procedure in 2013 16 12.5%   
Transplant, Heart 20 0 0.0% 3.2%

The Johns Hopkins All Children's Heart Institute has published in the peer reviewed literature our outcomes after the Norwood procedure and Heart Transplantation. View the References about the Norwood procedure and Heart Transplantation.

If you have questions about any of the outcomes data you see above, please call (727) -767-4932

Learn more about the Johns Hopkins All Children's Heart Institute


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