Load of Case-mix Distribution & Impact of Specialized Pediatric Cardiovascular ICU on Pediatric Cardiac Surgical Outcome

  • Dr Mahmoud Elbarbary, Abdulaziz Cardiac Center (KACC), National Guard Health Affairs P.O. Box 22490 Riyadh 11426, Saudi Arabia,, Saudi Arabia
  • Dr Riyadh Abu Sulaiman, King Abdulaziz Cardiac Center (KACC), National Guard Health Affairs P.O. Box 22490 Riyadh 11426, Saudi Arabia,
  • Dr Hani Najm, King Abdulaziz Cardiac Center (KACC), Saudi Arabia

    • Aim of study: we aimed to examine the effect of having specialized pediatric cardiac ICU ands effect of the Load of Case-mix Distribution (LCD) on the outcome of pediatric cardiac surgery program.

    Methodology:We used in our databaseboth RACHS-1 score and Aristotle score from which we calculated the risk-adjusted SMR (The Standardized Mortality Ratio). We developed a statistical model to measure the Load of Case-mix Distribution (LCD) and aimed to examine this against the variability of the SMR. We also compared this to the available data from the CCAD (Central Cardiac Audit Database – UK)

    Results: The results show the risk-adjusted SMR of our center is consistently < 1 in all risk categories. It also shows that the SMR of our center is less than that of CCAD in all categories except in category-3. Further analysis was done for category-3 in relation to the opening of a dedicated specialized pediatric cardiovascular ICU (PCVICU) in February 2002. It revealed a drop of SMR value of KACC in category-3 from 1.3 (for general PICU period) to 0.43(for PCVICU period). The LCD effect was also documented.

    Conclusion: The results may indicate that patients classified by RACHS-1 score as category-3 or above, are better to be managed postoperatively in a specialized pediatric cardiovascular ICU. Also by case mix effect, it is better not to operate simultaneously on multiple high risk patients during the same time. The results carry potential benefits of risk score to guide the PCICU resource utilization.