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They are among the most complex procedures done on the most vital organ of some of the most vulnerable among us: Heart surgery on infants and children, rare enough that you can still count on one hand the number of hospitals in Pennsylvania that do them, including Geisinger Children’s Hospital.
A new report details, for the first time, how many have been done in the state and how successful nine complicated “benchmark” procedures were at each facility — though when it comes to Geisinger, the hospital’s foray into things like “Ventricular Septal Defect” or “Tetralogy of Fallot” repairs were limited due to a lack of surgeons during the four years reviewed, 2009-12.
The Pennsylvania Health Care Cost Containment Council released the report, dubbed “Pediatric and Congenital Heart Surgery” this morning. The report notes the council worked with four children’s hospitals in Pennsylvania and one in Wilmington, Delaware, in compiling the data.
Geisinger Children’s Hospital was one of the four in the Keystone State, along with Children’s Hospital of Philadelphia, Children’s Hospital of Pittsburgh of UPMC, and Penn State Hershey Children’s Hospital. The Delaware hospital was Nemours A.I. duPont Hospital for Children.
Of the five, Geisinger had far fewer procedures than the others. Combined, the five performed 6,313 child heart procedures in that time. Of that, Geisinger conducted 180, or 2.9 percent.
“We’re one of the smaller programs in Pennsylvania, but we still strive for the highest quality,” said Dr. Robert Mangano, Geisinger Health System director of pediatric cardiology.
The study also looked at nine benchmark procedures “determined by the Society of Thoracic Surgeons (STS) to be the most common and standardized surgical repairs.” Geisinger’s share of those procedures among the five hospitals is even smaller: 33 of 1,697 done over four years, or 1.9 percent.
To the layman, many of them may sound downright futuristic, from fixing a congenital hole between the two main chambers of the heart — a condition that can sometimes be delayed long enough to mend itself — to one in which the two main arteries carrying blood out of the heart are abnormally connected, requiring surgery within a few days of birth.
The procedures can be extremely delicate for reasons both obvious and subtle, Mangano said. To start with, the heart itself may be little more than the size of a walnut in newborns, and arteries being re-positioned in certain procedures could be a scant one millimeter in diameter.
The nine benchmark procedures are all open-heart, requiring the use of bypass machine, and infants have so little blood that, unlike adults, they can’t afford to have much of it in the machine at any one time. Advanced techniques have helped overcome that problem, Mangano said. In fact, Geisinger recently invested in a new bypass machine for pediatric operations.
The report also lists mortality rates — the number of patients who died — as well as a complex calculation of a “confidence interval” designed to show whether the data for an individual hospital’s procedure was statistically significant when compared to STS averages.
Generally, the five hospitals tended to do better than the average. In about half the cases where full data was reported for all four years, there were no deaths.
Mortality data for Geisinger was not included because only three years of data were available, but Mangano said the hospital did an internal comparison of its outcomes. “Mortality was zero, so we’re pretty happy with that.”
Mangano also noted the number of procedures at Geisinger have increased since 2012 because the hospital has committed to improving and expanding the pediatric cardiac program.
“This program is longstanding, it goes back 30 some years,” Mangano said. “I see patients now in their 20s and 30s who were operated on here by surgeons when they were eight.”
The report notes the effort to compile the data was initiated by the pediatric heart surgeons associated with the five hospitals.
“This is an important initiative for patients, their families and their physicians,” Council Executive Director Joe Martin said in a media release accompanying the report. “This report will provide families with a useful tool to help them determine the treatment options for their child.”
Mangano said Geisinger is bringing another surgeon on board and “working very hard to provide all-encompassing pediatric care here.”
While Geisinger currently enjoys bragging rights as the only hospital in the region offering such surgeries, the exclusivity may not last.
In a written statement from Commonwealth Health Systems, which owns Wilkes-Barre General and several other regional facilities, Spokeswoman Renita Fennick said “Commonwealth Health Moses Taylor Hospital will be extending its pediatric specialties to include pediatric cardiology and pediatric neurology. We will have details when those service lines begin.”