Published online April 3, 2006
PEDIATRICS Vol. 117 No. 4 April 2006, pp. 1307-1313 (doi:10.1542/peds.2005-1544)
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In-Hospital Mortality for Children With Hypoplastic Left Heart Syndrome After Stage I Surgical Palliation: Teaching Versus Nonteaching Hospitals

Jay G. Berry, MDa, Collin G. Cowley, MDb, Charles J. Hoff, PhDb,{dagger} and Rajendu Srivastava, MD, FRCPC, MPHb

a Harvard Pediatric Health Services Research Fellowship Program, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
b Department of Pediatrics, University of Utah, Primary Children's Medical Center, Salt Lake City, Utah

OBJECTIVES. Teaching hospitals are perceived to provide a higher quality of care for the treatment of rare disease and complex patients. A substantial proportion of stage I palliation for hypoplastic left heart syndrome (HLHS) may be performed in nonteaching hospitals. This study compares the in-hospital mortality of stage I palliation between teaching and nonteaching hospitals.

METHODS. The authors conducted a retrospective cohort study using the Kids' Inpatient Database 1997 and 2000. Patients with HLHS undergoing stage I palliation were identified using International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedural codes.

RESULTS. Seven hundred fifty-four and 880 discharges of children with HLHS undergoing stage I palliation in 1997 and 2000, respectively, were identified. The in-hospital mortality for the study population was 28% in 1997 and 24% in 2000. Twenty percent of stage I palliation operations were performed in nonteaching hospitals in 1997. Two percent of operations were performed in nonteaching hospitals in 2000. In 1997 only, in-hospital mortality remained higher in nonteaching hospitals after controlling for stage I palliation hospital volume and condition-severity diagnoses. Low-volume hospitals performing stage I palliation were associated with increased in-hospital mortality in 1997 and 2000.

CONCLUSIONS. Patients with HLHS undergoing stage I palliation in nonteaching hospitals experienced increased in-hospital mortality in 1997. A significant reduction in the number of stage I palliation procedures performed in nonteaching hospitals occurred between 1997 and 2000. This centralization of stage I palliation into teaching hospitals, along with advances in postoperative medical and surgical care for these children, was associated with a decrease in mortality. Patients in low-volume hospitals performing stage I palliation continued to experience increased mortality in 2000.

Key Words: teaching hospital • hypoplastic left heart syndrome • mortality • Kids Inpatient Database • resource use

Abbreviations: HLHS—hypoplastic left heart syndrome • KID—Kids' Inpatient Database • ICD-9-CM—International Classification of Diseases, Ninth Revision, Clinical Modification • AHA—American Hospital Association • OR—odds ratio • CI—confidence interval • IQR—interquartile range

Accepted Sep 20, 2005.