At Nicklaus Children's Hospital our programmatic goal is to improve the care of patients with congenital heart disease, minimizing trauma to patients and families over the course of their lifetimes. We strive to be the most innovative and transparent congenital heart program in the world. To achieve this we measure our performance continuously and report our results publicly in real time. This practice enhances our ability to identify and correct clinical problems and provides our colleagues, patients and families with accurate and useful outcomes data for decision making.

This Website only gives a snapshot of the available information. The data you see below is generated dynamically by our cardiac program database, in real time, every time you load this page. It is the same data we submit to the Society of Thoracic Surgeon’s Congenital Heart Surgery Database (STS) and that we submit to the Florida Agency for Healthcare Administration.

How to Use the Real Time Outcomes (RTO) Data

The following section will be used to help filter the different analysis sections of the site. Please review the instructions to better navigate the site to view all of the valuable information it provides

STS Comparison filter section

STS Comparison and Surgeon Outcomes

By clicking the button “STS Comparison and Surgeon Outcomes”, the site will compare the Nicklaus Children’s Hospital most recent 4 year data to the most recently published STS 4 year analysis and provide surgeon specific reporting for the most recent 4 year period.

By Surgeon

The surgeon specific reporting is ONLY available by clicking the button in order to preserve accuracy of comparative outcomes to a 4 year period. The “By Surgeon” button will be available as the last column in each of the respective Analysis data tables.

Start and End dates

The Start Date and End Date criterion will allow you to filter the cardiac program for any specific time period that is equal to or greater than a 365 day range. The system will not allow date ranges that provide data for less than 1 year of data. The maximum start date that you can select is 365 days from the current day and the maximum end date is the current day.

Submit button

By clicking the “Submit” button, this will cause the data to filter for the specific time period entered into the Start Date and End Date fields. When clicking this button, the Surgeon specific reporting will not be available.

What are STS benchmark procedures in reference to STS

There are 10 benchmark procedure groups which are defined by the Society of Thoracic Surgeons (STS) and are the most common and standardized surgical operations. The benchmark procedures provide a standard for measuring the outcomes of 100+ participating congenital cardiac surgical centers in North America. The 10 benchmark procedures defined by the STS are:

  • Ventricular Septal Defect (VSD) repair
  • Tetralogy of Fallot (TOF) repair
  • Complete atrioventricular canal repair (Complete atrioventricular septal defect repair (CAVSD))
  • Arterial switch operation (ASO)
  • Arterial switch + VSD repair (ASO+VSD)
  • Glenn/HemiFontan
  • Fontan operation
  • Truncus arteriosus repair
  • Norwood procedure
  • Off-Bypass Coarctation
What is a STAT score and what does it mean

The Society of Thoracic Surgeons (STS)-European Association for Cardio-Thoracic Surgery (EACTS) Mortality Categories (STAT Mortality Categories)

The STAT mortality categories was designed to group procedures into categories to help identify the level of complexity and risk of mortality associated to the type of procedure. The categories range from 1 to 5 with a score of 1 represents the least complex procedures with the lowest risk of mortality and a score of 5 with the most complex operations with the highest risk of mortality.

What are the age groups

The Society of Thoracic Surgeons (STS) reports outcomes in groupings based on age. The different age groupings are defined by the age of the patient based on their day of birth. The following four age groups are defined below:

  • Neonates (0 to 30 days)
  • Infants (31 days to 1 year)
  • Children (> 1 year to < 18 years)
  • Adults (18 years and older)
What is risk adjustment and why is it needed (referenced here on STS website)?

The STS incorporates a case-mix (risk) adjustment to allow for more meaningful comparison of any given hospital to the combination of all hospitals performing pediatric and congenital heart surgery and participating in the STS surgical database. Adjustment for case mix is especially important because hospitals that tend to treat sicker patients are expected to have higher rates of mortality, which may be due to the condition of these patients or the complexity of the procedures required to treat them and not necessarily because of the care they received. To level the playing field, the STS mortality risk model takes into account the variables which can affect surgical results.

It is not easy to assess performance in the field of congenital heart surgery. One reason for this is the significant differences in the types of heart defects treated at different hospitals. Go to Additional Resources for more information.

Outcomes Data and Choosing a Cardiac Program

In deciding where your child or other family member should be cared for it is important to ask questions. These are some of the questions we encourage parents and patients to ask of us at Nicklaus Children's Hospital:

  • How many patients with similar diagnosis are seen in the center in a year, the past four years, and the past ten years?
  • How many open heart operations does the program do a year? How many of the type of operation that your child requires are done a year, the past four years, and the past ten years?
  • Where does the volume of the program stand in relation to the volume of other programs in the area? What are the outcomes? Are they publicly available?
  • What are the outcomes in relation to the publicly available outcomes of other centers in the area, in the region, in the country?
  • It is completely appropriate to insist to see the relevant Society of Thoracic Surgeons Congenital Heart Surgery Database tables so you can compare actual outcomes rather than vague approximations. This is explicitly allowed by the STS. Ask to see the risk adjusted outcomes as well as they are key indicator of programmatic results.
  • There are other outcome measures that are relevant in some cases. What is the rate of complications like renal failure, tracheostomy, gastrostomy, and pacemaker placement?
  • Ask about the resources available.
    • Are there two or more surgeons on site? What is their training and experience?
    • What is the experience and training of the other physicians on the cardiac team: echocardiographers, intensivists, interventional cardiologists, electrophysiologists?
    • What is the programmatic experience? How stable is program? Are the results being reported the results for the people currently in the program?
    • Is there a dedicated Cardiac Intensive Care Unit that cares only for cardiac patients with in house physician coverage 24/7? Are the physicians dedicated to caring only for patients with congenital heart disease?
    • Are there dedicated pediatric echocardiographers who routinely perform intraoperative transesophageal echocardiography?
    • Is there a dedicated pediatric cardiac MRI program?
    • Is there a dedicated pediatric cardiac catheterization laboratory that specializes in congenital heart disease? Or are children with congenital heart disease catherized in an adult laboratory?
    • Is there a dedicated cardiac anesthesia team?
    • Is there a dedicated perfusion (heart lung machine) team that specializes in congenital heart disease?
    • Is there a High Risk Clinic for at risk patients after neonatal palliative surgery?
    • Are there dedicated contact people available before, during and after surgery? Ask to meet those contact persons.
    • Meet the surgeons. Ask questions. Ask for a tour.
    • Expect and demand the highest level of care for your child or family member.

Analyzing Outcomes Data

In evaluating programmatic results it is very important to recognize that every child and every patient is different. Outcomes data is an aggregation of patients: we care for individual patients with differing risk factors, differing anatomy, and differing history. In addition, in comparing programmatic results, it is important to recognize that different programs may have different philosophies in caring for patients and that these philosophical differences do not imply that one program is “better” than another. What is best for your child or family member is the question.

The outcomes data above is an aggregation of patients and the risk stratification presented is based on type of operation only. More complex risk stratification methods are also used by the Society of Thoracic Surgeon’s Database. Metrics that include birth weight, genetic anomalies and severity of illness are also collected by the STS and analyzed. These metrics are then presented as Observed (actual) Mortality versus Expected (predicted) Mortality based on severity. We look forward to sharing this data with you in person.

We are hopeful that you find the information useful. Should you require more specific outcomes data or more information regarding our program, please do not hesitate to contact the main office at 305-663-8401 or our nurse navigator at 844-NCH-EART (844-624-3278) or 786-624-3610.

*** The Nicklaus Children’s RTO v2.0 website does not have access to the aggregate STS data and can only report unadjusted mortality rates. The data represented on this site presents raw mortality rates compared to the overall mortality rates of all centers participating in the STS registry.