The Relationship Between Hospital Surgical Case Volumes and Mortality Rates in Pediatric Cardiac Surgery: A National Sample, 1988–2005 Karl F. Welke,

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The Relationship Between Hospital Surgical Case Volumes and Mortality Rates in Pediatric Cardiac Surgery: A National Sample, 1988–2005 Karl F. Welke, MD, MS, Brian S. Diggs, PhD, Tara Karamlou, MD, MS, Ross M. Ungerleider, MD, MBA The Annals of Thoracic Surgery Volume 86, Issue 3, Pages 889-896 (September 2008) DOI: 10.1016/j.athoracsur.2008.04.077 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Identification of a hospital threshold volume associated with lower mortality. Presented are the odds ratio (solid line) and 95% confidence intervals (dashed lines) of high-volume hospitals vs low-volume hospitals from a logistic regression model of mortality. The model is also adjusted for year, Risk Adjustment in Congenital Heart Surgery categories, and age. The threshold volume dividing high- and low-volume hospitals is the value along the horizontal axis. For thresholds exceeding 100 cases per year, high-volume hospitals had a significantly lower mortality rate than low-volume hospitals. The Annals of Thoracic Surgery 2008 86, 889-896DOI: (10.1016/j.athoracsur.2008.04.077) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Individual hospital mortality rates are presented according to annual pediatric cardiac surgical volume. Not shown are 291 hospitals with fewer than 5 cases per year. The size of the circle at a given hospital annual volume and mortality rate represents the number of hospitals with that mortality rate at that volume. The horizontal line is the overall raw mortality rate (6.07%). The lines above and below this line represent the confidence intervals (CIs) of a hypothetical single institution at that volume and the average mortality rate; these give an idea of what mortality rates would be statistically different at that volume. The four marks with error bars are the collective mortality rates and 95% CIs for the four volume groups (< 20 cases/y, 20 to 100 cases/y, 101 to 200 cases/y, and > 200 cases/y). The Annals of Thoracic Surgery 2008 86, 889-896DOI: (10.1016/j.athoracsur.2008.04.077) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions