Reevaluating Congenital Heart Surgery Center Performance Using Operative Mortality

In order to best estimate observed-to-expected operative mortality ratios for more than 100 congenital heart centers in North America, The Society of Thoracic Surgeons compared their current approach to approaches that incorporate information on diagnoses as moderators of procedures, other unused risk factors, and additional variation in confidence interval construction. This comparison allowed the authors to characterize center performance using Bayesian additive regression trees and lasso models used to link operative mortality to diagnosis-procedure categories, procedure-specific risk factors, and syndromes/abnormalities. The authors concluded that, after using the new approach, up to 16 percent of hospitals changed performance categories, most improving in performance. Given the significance of this type of quality report for congenital heart centers, they determined that the new method of analysis should be considered.