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Ann Thorac Surg 2006;81:1557-1560
© 2006 The Society of Thoracic Surgeons

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Editorial

Defining Operative Mortality: It Should Be Easy, But Is It?

Division of Cardiovascular Surgery, University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada

^_* Address correspondence to Dr Williams, Division of Cardiovascular Surgery, The Hospital for Sick Children, 555 University Ave, Room 1525, Toronto, ON, Canada M5G 1X8 (Email: bill.williams@sickkids.ca).

The first 300 words of the full text of this article appear below.

Jacobs and colleagues [1] presented a reasoned approach to defining death in the context of a registry database for congenital heart surgery. Their purpose is to standardize data entry to allow comparisons of operative mortality risk among institutions (and surgeons). It is interesting that we continue to focus on death after congenital heart surgery rather than focusing on the remarkable improvement in survival rate.

The inference of their paper, unproven although intuitively satisfying, is that lower operative mortality rate indicates better institutional performance. However one could imagine a scenario in which an institution adopts a protocol that accepts a higher operative risk procedure for the perceived benefit of a better long-term outcome. Such is the case in babies with a borderline left ventricle in which a biventricular repair may be attempted rather than accepting the late problems of single ventricle palliation. The change from atrial to arterial repair of infants with transposition is an historical example of accepting a higher early risk for the potential of long-term patient benefit of the more anatomic repair. Therefore some variance in institutional outcome must be tolerated for those willing to explore the limits of surgical intervention.

See page 1937

Comparisons of institutional risk in the surgical management of children with congenital heart disease is complicated by the diverse nature and rarity of congenital heart disease, differing case-mix among institutions, and the current low operative risk. Analysis of results after congenital heart surgery is affected by data quality, case-mix differences, and chance alone. Data quality is dependent on dedicated personnel who must achieve and maintain data integrity, and the use of standard nomenclature and definitions. Jacobs and colleagues [1] address the later point in defining death after surgery.

The essence of Jacob and colleagues' [1] definition of operative . . . [Full Text of this Article]

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Ann. Thorac. Surg. 2006 81: 1937-1941. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

				J. P. Jacobs, M. L. Jacobs, C. Mavroudis, B. Maruszewski, C. I. Tchervenkov, F. G. Lacour-Gayet, D. R. Clarke, T. Yeh Jr, H. L. Walters III, H. Kurosawa, et al. What is Operative Morbidity? Defining Complications in a Surgical Registry Database Ann. Thorac. Surg., October 1, 2007; 84(4): 1416 - 1421. [Full Text] [PDF]