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Referring children who need cardiac surgery to high-volume regional hospitals reduces deaths but increases travel distance

Referring children who need cardiac surgery from low-volume to high-volume hospitals that conduct many pediatric cardiac surgeries a year (regionalization of surgery) can save children's lives, even though the children and their families would have to travel further for the surgery. However, more studies are needed to determine if regionalization is the most feasible and cost-effective way to reduce surgery-related deaths in these children, concludes a study supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00028).

Ruey-Kang R. Chang, M.D., M.P.H., of Harbor-University of California, Los Angeles (UCLA) Medical Center, and Thomas S. Klitzner, M.D., Ph.D., of the UCLA School of Medicine, studied discharge data from California hospitals that performed 10 or more pediatric cardiac surgeries from 1995 to 1997. They simulated regionalization of surgery by redistributing patients from low-volume hospitals (less than 70 pediatric cardiac surgeries per year) or medium volume hospitals (70 to less than 170 surgeries per year) to the nearest high-volume hospital (170 or more surgeries per year). During the 2 years studied, 6,592 children underwent cardiac surgeries in California, with 352 in-hospital deaths (5.34 percent). Regionalization of pediatric cardiac surgery had no apparent effect on reducing surgical deaths until more than one-third of low-volume hospitals were "closed," that is, patients were sent to the nearest high-volume hospitals.

The overall mortality rate decreased from 5.34 percent to 4.08 percent (avoidance of 83 deaths), when all cases from both low- and medium-volume hospitals were referred to high-volume hospitals. However, this required closure of three-fourths of the pediatric cardiac centers (41 percent of all patients). When only high-risk surgeries were selectively referred from low- and medium-volume to high-volume hospitals (11 percent of patients), the overall mortality rate decreased to 4.6 percent (49 deaths avoided). On average, children had to travel 45.4 miles, which increased by 12.7 miles when all surgeries were referred to high-volume hospitals.

More details are in "Can regionalization decrease the number of deaths for children who undergo cardiac surgery? A theoretical analysis," by Drs. Chang and Klitzner, in the February 2002 Pediatrics 109(2), pp. 173-181.

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