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Child heart surgery outcomes better than national average A comparison of mortality rates from 54 pediatric cardiac surgery centers in the United States and Canada shows that pediatric cardiac surgical mortality rates at MUSC are well below the average of all centers for all procedures analyzed. Lower mortality rates clearly indicate positive outcomes for MUSC patients.  The pediatric cardiac surgery service at MUSC is the only one in South Carolina. In collaboration with pediatric cardiologists in Greenville, Columbia and Florence, it serves patients from the entire state through the Children's Heart Program of South Carolina. The Pediatric Cardiac Care Consortium (PCCC) just released the analyzed data from its member centers for the period 1996 to 2000.  The following data were generated for each of 18 cardiac procedures: number of operations, observed deaths, percent mortality, expected deaths for the procedure based on PCCC norms, and the standardized difference (permitting comparison of MUSC to all the institutions). A standardized difference (SD) below 0 indicates better performance than the average, a value above 0 is worse. A value less than -2 is significantly better than average. The overall mortality rate for all institutions was 6.7 percent, and the mortality rate at MUSC was about a quarter of that, 1.58 percent.  MUSC mortality rates were below the average of the other institutions for the 13 procedures where the number of operations was sufficient to derive statistically significant data. In the procedures where there were not enough data for statistically significant comparisons, MUSC generally had no deaths.   One of the areas where MUSC mortality rates were dramatically below average was the Norwood procedure, which is the first stage of repair for an infant born with only a single functioning heart pumping chamber, or ventricle, and no aorta.  During the period of the study, 63 of  these cases were done at MUSC with 10 deaths prior to 30 days after the procedure, translating to a 15 percent mortality rate. The average mortality rate for this procedure at all the centers was about 3.5 times as high at 50 percent. “Two superb pediatric cardiac surgeons, Fred Crawford Jr., M.D., and Scott M. Bradley, M.D., and a dedicated group of pediatric cardiac intensivists are probably the biggest  factors in our success,” said J. Philip Saul, M.D., medical director for children's services at MUSC. “Further, as the only pediatric cardiac surgical center in South Carolina, we do a larger volume of procedures than some of the other centers, so there are sufficient cases to be a center of true excellence. In North Carolina, for example, there are five competing centers with the result that no one center can produce the kind of outcomes that we do.” He also attributes MUSC's success to a strong team approach, providing everything the patient needs, including dedicated pediatric cardiac surgeons, intensive care specialists, catheterization specialists, imaging specialists and anesthesiologists. “The  bottom line,” he said, “is you need a team of specialists, all practicing state-of-the-art care and all dedicated to children.” The PCCC was developed about 15 years ago when it was recognized that there was a wide variation in outcomes among pediatric cardiac centers in the U.S. It operates as a self-evaluation mechanism where patient outcome data from each member center go to a central data base located at the University of Minnesota Hospital and Clinic. The group processes data and compares centers to let individual members know how they compare to the others institutions.  Centers not doing well can see where they need to make improvements.