Larger Centers May Produce Better Outcomes: Is Regionalization in Congenital Heart Surgery a Superior Model?

Efforts to correlate outcomes of children undergoing heart surgery with center volume and characteristics are not novel. In the current era, outcomes are defined as, and in many cases limited to, mortality rates. Over the past two decades, several investigators have explored various aspects of the volume–mortality relationship. The association between center volume and mortality, although not uniform, is highly implicated by the current literature. Notwithstanding, varied population densities in the United States makes regionalization of specialized services, such as pediatric cardiac surgery, undeniably challenging. There may be an unfortunate reality that larger centers have some advantage in achieving, at the very least, timely measures. However, as pediatric cardiac surgery progresses as a specialty, the definition of ‘outcomes’ must be expanded beyond simplified, dichotomous parameters. While mortality has been our historical primary focus, as it should be, it is reasonable to propose that our focus should be increasingly refined towards patient- and family-centric measures, including morbidity, cost/value ratio, and overall hospital experience.