Regionalization of congenital heart surgery: Time for a rational approach

Outcome variation in congenital heart surgery in the US is unacceptable. Mounting evidence shows higher volume programs have better outcomes than lower volume programs. According to the publicly available Society of Thoracic Surgeons (STS) data reflecting 2014–2017, centers with ≤2% adjusted mortality rate (AMR) perform an average of 300 cases per year while centers with >4% AMR perform an average of only 100 cases per year. Regionalization by collapsing low volume centers into fewer high volume centers would reduce mortality, but would also impact travel burden, hospital infrastructure, and medical education. A rational approach minimizes these impacts while achieving quality standards set collaboratively with professional societies. Ideally, regionalization of the over 150 congenital heart surgery programs operating today to 71 centers each performing 250–300 or more cases per year maintains a program for each state with a population of 2 million or more people and minimizes travel burden. These regional centers would work in concert with pediatric cardiology centers where patients could receive local diagnostic and long term follow up care.