The impact of continuous quality improvement on pediatric cardiac surgery

Abstract

The recognition that outcomes in pediatric cardiac surgery were in need of closer assessment became evident in the early 1990s. The courageous disclosure by a prominent congenital heart surgeon of a cluster of surgical failures and the forced closure of two separate pediatric heart surgery programs suggested that more vigilance was required for this highly specialized area of surgery. The development of registry databases in Europe and North America for congenital heart surgery patients is described. The maturation of these databases and the development of a common nomenclature and risk stratification scheme are also reviewed. Now that pediatric cardiac surgery outcomes are being tracked reliably, significant variation in these outcomes within and between centers has become evident, especially with higher risk procedures. Strategies to address this variation and to improve the quality of pediatric heart surgery are discussed.