{"doi":"10.1017/s1047951124026568","title":"Hospital variation in post-operative cardiac extracorporeal membrane oxygenation use and relationship to post-operative mortality","abstract":"<jats:title>Abstract</jats:title><jats:sec id=\"S1047951124026568_as1\"><jats:title>Objective:</jats:title><jats:p>It is unclear how extracorporeal membrane oxygenation use varies across paediatric cardiac surgical programmes and how it relates to post-operative mortality. We aimed to determine hospital-level variation in post-operative extracorporeal membrane oxygenation use and its association with case-mix adjusted mortality.</jats:p></jats:sec><jats:sec id=\"S1047951124026568_as2\"><jats:title>Methods:</jats:title><jats:p>Retrospective analysis of 37 hospitals contributing to the Pediatric Cardiac Critical Care Consortium clinical registry from 1 August 2014 to 31 December 2019. Hospitalisations including cardiothoracic surgery and post-operative admission to paediatric cardiac ICUs were included. Two-level multivariable logistic regression with hospital random effect was used to determine case-mix adjusted post-operative extracorporeal membrane oxygenation use rates and in-hospital mortality. Hospitals were grouped into extracorporeal membrane oxygenation use tertiles, and mortality was compared across tertiles.</jats:p></jats:sec><jats:sec id=\"S1047951124026568_as3\"><jats:title>Results:</jats:title><jats:p>There were 43,640 eligible surgical hospitalisations; 1397 (3.2%) included at least one post-operative extracorporeal membrane oxygenation run. Case-mix adjusted extracorporeal membrane oxygenation rates varied more than sevenfold (0.9–6.9%) across hospitals, and adjusted mortality varied 10-fold (0–5.5%). Extracorporeal membrane oxygenation rates were 2.0%, 3.5%, and 5.2%, respectively, for low, middle, and high extracorporeal membrane oxygenation use tertiles (<jats:italic>P</jats:italic> &lt; 0.0001), and mortality rates were 1.9%, 3.0%, and 3.1% (<jats:italic>p</jats:italic> &lt; 0.0001), respectively. High extracorporeal membrane oxygenation use hospitals were more likely to initiate extracorporeal membrane oxygenation support intraoperatively (1.6% vs. 0.6% low and 1.1% middle, <jats:italic>p</jats:italic> &lt; 0.0001). Extracorporeal membrane oxygenation indications were similar across hospital tertiles. When extracorporeal cardiopulmonary resuscitation was excluded, variation in extracorporeal membrane oxygenation use rates persisted (1.5%, 2.6%, 3.8%, <jats:italic>p</jats:italic> &lt; 0.001).</jats:p></jats:sec><jats:sec id=\"S1047951124026568_as4\"><jats:title>Conclusions:</jats:title><jats:p>There is hospital variation in adjusted post-operative extracorporeal membrane oxygenation use after paediatric cardiac surgery and a significant association with adjusted post-operative mortality. These findings suggest that post-operative extracorporeal membrane oxygenation use could be a complementary quality metric to mortality to assess performance of cardiac surgical programmes.</jats:p></jats:sec>","journal":"Cardiology in the Young","year":2024,"id":597917,"datarank":0.20794415416798362,"base_score":1.3862943611198906,"endowment":1.3862943611198906,"self_citation_contribution":0.20794415416798362,"citation_network_contribution":0.0,"self_endowment_contribution":0.20794415416798362,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":289368,"name":"J. William Gaynor","orcid":"0000-0001-7955-5604","position":1,"is_corresponding":false},{"id":1280475,"name":"Wenying Zhang","orcid":"0000-0003-0949-1646","position":2,"is_corresponding":false},{"id":952017,"name":"Mousumi Banerjee","orcid":"0000-0003-4346-246X","position":3,"is_corresponding":false},{"id":1531931,"name":"Yuliya A. Domnina","orcid":null,"position":4,"is_corresponding":false},{"id":374718,"name":"Michael Gaies","orcid":"0000-0001-5061-0059","position":5,"is_corresponding":false},{"id":1110779,"name":"Marissa A. Brunetti","orcid":"0009-0001-4949-9901","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Hospital variation in post-operative cardiac extracorporeal membrane oxygenation use and relationship to post-operative mortality.","abstract":"<h4>Objective</h4>It is unclear how extracorporeal membrane oxygenation use varies across paediatric cardiac surgical programmes and how it relates to post-operative mortality. We aimed to determine hospital-level variation in post-operative extracorporeal membrane oxygenation use and its association with case-mix adjusted mortality.<h4>Methods</h4>Retrospective analysis of 37 hospitals contributing to the Pediatric Cardiac Critical Care Consortium clinical registry from 1 August 2014 to 31 December 2019. Hospitalisations including cardiothoracic surgery and post-operative admission to paediatric cardiac ICUs were included. Two-level multivariable logistic regression with hospital random effect was used to determine case-mix adjusted post-operative extracorporeal membrane oxygenation use rates and in-hospital mortality. Hospitals were grouped into extracorporeal membrane oxygenation use tertiles, and mortality was compared across tertiles.<h4>Results</h4>There were 43,640 eligible surgical hospitalisations; 1397 (3.2%) included at least one post-operative extracorporeal membrane oxygenation run. Case-mix adjusted extracorporeal membrane oxygenation rates varied more than sevenfold (0.9-6.9%) across hospitals, and adjusted mortality varied 10-fold (0-5.5%). Extracorporeal membrane oxygenation rates were 2.0%, 3.5%, and 5.2%, respectively, for low, middle, and high extracorporeal membrane oxygenation use tertiles (<i>P</i> < 0.0001), and mortality rates were 1.9%, 3.0%, and 3.1% (<i>p</i> < 0.0001), respectively. High extracorporeal membrane oxygenation use hospitals were more likely to initiate extracorporeal membrane oxygenation support intraoperatively (1.6% vs. 0.6% low and 1.1% middle, <i>p</i> < 0.0001). Extracorporeal membrane oxygenation indications were similar across hospital tertiles. When extracorporeal cardiopulmonary resuscitation was excluded, variation in extracorporeal membrane oxygenation use rates persisted (1.5%, 2.6%, 3.8%, <i>p</i> < 0.001).<h4>Conclusions</h4>There is hospital variation in adjusted post-operative extracorporeal membrane oxygenation use after paediatric cardiac surgery and a significant association with adjusted post-operative mortality. These findings suggest that post-operative extracorporeal membrane oxygenation use could be a complementary quality metric to mortality to assess performance of cardiac surgical programmes.","is_dataset_classified":null,"base_score":0.0,"endowment":0.0,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"39364539","pmcid":null,"openalex_id":null,"authors":[],"funders":[],"total_grants":0,"fwci":null,"citation_percentile":null,"influential_citations":0,"citation_trend":[],"oa_status":"closed","license":null,"oa_locations":[],"fields_of_study":[],"mesh_terms":["Humans","Heart Defects, Congenital","Postoperative Complications","Extracorporeal Membrane Oxygenation","Cardiac Surgical Procedures","Registries","Hospital Mortality","Retrospective Studies","Child","Child, Preschool","Infant","Infant, Newborn","Hospitals","United States","Female","Male"],"keywords":["Heart Disease","Perioperative Care","Extracorporeal Membrane Oxygenation","Icus","Cardiac Surgical Procedure","Chds"],"sdg_mappings":[],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-07-28T14:35:17.701230Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}