Children's Hospital Colorado
Heart institute
Heart institute

Our Cardiac Surgery Outcomes Make Us One of the Top Pediatric Heart Hospitals in the U.S.

“Do research before making decisions to seek care at another hospital outside of your community or state. Talk to the physicians and other medical staff who will be caring for your child. These prenatal conversations along with extensive research is what led us to pursue Children’s Colorado  for our son's serious heart condition.”
— Heart warrior mom

It’s an honor to care for your child and your family. Every day, our pediatric cardiology team works diligently to ensure that your child has access to safe and effective treatments in a family-centered environment.

At the Heart Institute at Children’s Hospital Colorado, we evaluate our success by monitoring and comparing our cardiology outcomes with other top pediatric cardiology hospitals. We also routinely check and update our quality and patient safety outcomes to ensure that families have access to the latest information. Transparency with our patients and colleagues is one of the keys to our success as one of the best hospitals for pediatric heart surgery in the U.S.



What are pediatric cardiology outcomes?

In the medical world, the term “outcomes” means “success rates.” Pediatric cardiology programs measure and report their outcomes to help parents make the best decision about where to take their child for heart surgery.

Expand the windows below to view some of the many things we measure in order to ensure that we’re providing the highest level of cardiac care for every patient.

Heart surgery programs typically report their overall survival rate as well as survival rates based on the complexity of the surgery. At Children’s Colorado, our overall survival for all cardiac surgery patients, regardless of surgical complexity, is 97.3%. The national average is 97.1%.

97.3% Cardiac surgery survival rate at Children's Colorado

Source: STS July 2014 through June 2019

Cardiac surgical survival by complexity

Some congenital heart defects are more complex than others. Because there are so many types of heart defects, no pediatric heart program will see the exact same types of heart defects each year. The Society of Thoracic Surgeons (STS) organizes the types of surgeries into five categories of complexity, which are referred to as “STAT categories.”

About STAT categories

STAT categories organize heart surgeries into groups based on how risky or complex they are. The STAT 1 category indicates surgeries with the lowest risk of death, while the STAT 5 category indicates the surgeries with the highest risk of death. A hospital that has a high survival rate for STAT 5 cases indicates success at handling unpredictable situations during the operation and in recovery.

For STAT 5 neonatal surgeries, the most complex, the Heart Institute's survival rate is 88.2%, higher than the national average.

88.2% STAT 5 newborn cardiac surgery survival rate at Children's Colorado

Source: STS July 2014 through June 2019

Heart outcomes STAT 5 newborn survival.jpg

Cardiac surgery mortality

Surgery programs also report mortality, which is the percentage of patients who did not survive their operation. (The more complex the surgery, the higher the risk of mortality.)

Below are Children’s Colorado’s cardiac surgery mortality rates by STAT category, age of the patient and type of surgery.

Heart outcomes Newborn mortality by STAT category.jpg

Surgical outcomes: Adjusted mortality rate (AMR) by age

Age category Total cases Observed mortality rate Children's Colorado Expected mortality rate Children's Colorado Adjusted mortality rate Children's Colorado (95% confidence interval) STS
Newborns 330 7.0% 7.3% 7.7% [5.0,11.4] 8.1%
Newborns + Infants 823 4.6% 4.7% 4.7% [3.3,6.3] 4.7%
Newborns + Infants + Children 1492 3.0% 3.0% 3.1% [2.2,4.1] 3.0%
Newborns + Infants + Children + Adults 1690 2.7% 2.8% 2.8% [2.1,3.7] 2.9%

About adjusted mortality rate

The adjusted mortality rate (AMR) is a statistical evaluation developed by the STS that predicts a patient’s risk of undergoing surgery.  This evaluation attempts to include patient-related risk factors prior to surgery, such as age, weight and genetic factors, in addition to the patient’s surgical risk.  Using this method, the STS compares the actual patient outcomes (observed outcomes) to expected outcomes (those predicted by the statistical model).  Ultimately, a heart center should strive to have observed mortality that is the same or less than the expected mortality.

Heart outcomes Observed vs. expected mortality by STAT category.jpg

Index case mortality

July 2014 through June 2018

By specific operation Total operations Children's Colorado Children's Colorado mortality STS mortality
Arterial switch repair 23 0% 2.1%
Arterial switch repair + Ventricular septal defect 10 0% 4.7%
Atrioventricular canal defect repair 40 2.5% 2.6%
Glenn / Hemi-fontan 83 1.2% 2.0%
Fontan procedure 71 0% 1.0%
Norwood procedure 71 11.3% 14.9%
Tetralogy of Fallot repair 39 0% 1.2%
Truncus 9 0% 10.1%
Ventricular septal defect repair 122 0% 0.6%
Off bypass coarctation of the aorta 120 0.8% 1.4%

Average length of stay

The chart below shows the average number of days that children stay in the hospital for heart surgery, by STAT category. Cardiac surgery patients at Children’s Colorado spend less time in the hospital than the national average, indicating that they receive high quality care in the hospital that helps them go home sooner. The longer kids stay in the hospital after surgery, the more likely they are to have complications.

Heart outcomes Average length of stay in days by STAT category.jpg

How is the Heart Institute at Children's Colorado working to improve our surgical survival rates?

At the Heart Institute at Children's Colorado, we continue to pursue ways of providing excellent patient care and outcomes. To continue this endeavor, we have implemented a number of quality-improvement initiatives to help enhance our performance and continue doing what we do best: fixing little hearts. Some of our initiatives include:

  • Optimizing nutrition and growth of our patients
  • Reducing surgical site and catheter-related blood stream infections
  • Decreasing the number of days a patient stays in the hospital after heart surgery
  • Continuous review of individual patient outcomes to ensure that each patient had the best care possible

The Heart Institute approaches patient care as a team. Our team consists of specialized physicians, anesthesiologists, nurses, nutritionists, perfusionists, respiratory therapists, pharmacists and lab technicians. Our team approach ensures that every patient receives the best care possible, customized for each and every child.

Why do we measure surgical survival at the Heart Institute?

Survival after heart surgery is the most important measure of the success of a cardiac surgical procedure (although it is not the only outcome we routinely monitor and analyze). The number of children and adults who survive surgery for congenital heart disease has increased significantly over the last 15 years, which has helped us concentrate on preventing complications that may occur during a hospital stay after heart surgery.

In addition to survival rates, the STS database includes important information about surgical complications. This information allows us to analyze survival data in conjunction with complication data, so we can compare ourselves to other programs across the country. Comparisons with other top institutions help us better understand how we are performing as a program, as well as identify areas for improvement.

Learn more about the Heart Surgery Program at Children's Colorado.

About this data

What is surgical survival?

According to STS, "surgical survival" is defined as being alive at least 30 days after a procedure and having been discharged alive from the hospital. Utilizing the STS definition ensures that institutions across the country are using consistent data reporting methods. The STS report is updated every six months.

What is the source of this data?

This information is from the STS Congenital Heart Surgery Database, which is the largest congenital heart surgery database in the world.

Do we have a national benchmark?

Yes, the STS database allows us to compare our outcomes to other congenital heart surgery programs in North America. We, along with these other programs, submit data to the STS twice a year. The STS verifies the integrity of the data and generates reports that allow us to compare results with our peers across the country.

How often should the data be updated?

We continually track patient outcomes and will publicly report data on this website.

At Children’s Colorado, our heart transplant survival outcomes are better than the national average when we compare rates at both 30 days and one year after transplant. In fact, we have the highest survival rate in the nation for one-year heart transplant survival.

Our median time to heart transplant and median time in the hospital for transplant are both better than regional and national measures.

Heart outcomes pediatric heart transplant survival rate.jpg

Heart outcomes Median time to heart transplant.jpg

Heart outcomes Median time in hospital for heart transplant.jpg

What is heart transplant survival?

Heart transplant survival is the length of time a patient is alive after receiving a new heart. It may also be referred to as patient survival.

Why do we measure heart transplant survival rates?

We measure heart transplant survival to compare our program to others around the country and to identify potential areas for improvement. We also use the survival information to compare how we perform over time.

How we care for heart transplant patients

Excellent heart transplant care comes from a dedicated team. Our team consists of a multidisciplinary team of transplant cardiac specialists and surgeons who partner with dedicated transplant pharmacists, psychologists, social workers and other specialized team members for the best possible care. In addition, we provide cardiac rehabilitative services to help heart transplant recipients get back to good health and normal childhood activities sooner.

Learn more about the Heart Transplant Program at Children's Colorado.

About this data

What is the source of this data?

The heart transplant team at Children's Colorado maintains an internal database and reports data to the United Network for Organ Sharing. This data is publicly available from the Scientific Registry of Transplant Recipients (SRTR) at www.srtr.org.

Do we have a national benchmark?

Yes, the national benchmarks are based on data from the SRTR. As a heart transplant center, we regularly submit data and compare our patient outcomes to several national societies, including the SRTR and the Pediatric Heart Transplant Study.

How often will this data be updated?

Our internal database is updated on an ongoing basis. Results of all transplant programs’ survival rates are made available to the public by the SRTR in January and July of every year.

Another important measure of success for a hospital’s pediatric cardiology program is volume, which is the number of surgeries or procedures the hospital performs each year. Performing a higher number of surgeries (higher volume) means that the team has more experience performing these operations. Studies have shown that this experience correlates to better patient outcomes.

Here at Children’s Colorado, we perform hundreds of heart procedures each year. Reference the charts below to learn the number of surgeries, heart catheterizations and electrocardiograms we have performed over the last four years.

Surgical volume

Operation type 2015 2016 2017 2018
Cardio-pulmonary bypass 363 355 338 326
No cardio-pulmonary bypass 136 136 119 121
Other 55 66 56 69
Total 554 557 513 516

Heart outcomes Total cardiac catheterizations, including electrophysiology interventions.jpg

Heart outcomes Total electrophysiology interventions.jpg

Heart outcomes Total echocardiograms performed.jpg

We measure the rate of central line associated bloodstream infections (CLABSIs) in both of our inpatient units, the Cardiac Intensive Care Unit (CICU) and the Cardiac Progressive Care Unit (CPCU).

In 2017, we had a very low rate of CLABSI in our CPCU and CICU.  In 2018, despite good compliance with our preventive care bundles, we noted an increase in our CLABSI rate: 

  • In our CICU, CLABSIs went from less than 1 per 1,000 line days to 2.03 per 1,000 line days.
  • In our CPCU, CLABSIs increased from 0 per 1,000 line days to 1.17 per 1,000 line days.

As such, we have increased our monitoring and diligence in providing our preventative care bundle. As of May 2019, we have had an overall decrease in CLABSI rates in the Heart Institute.

What is a CLABSI?

When a patient is in the hospital for heart surgery, we place a small plastic tube called a catheter into the blood vessels near the heart. This is called a “central line.” Central lines are used to:

  • Deliver medication
  • Deliver nutritional supplements
  • Draw blood for blood tests
  • Monitor blood pressure

Sometimes, bacteria enter a patient’s central line, which means these bacteria can enter the patient’s bloodstream and make the patient sick. This is called a central line-associated bloodstream infection, or CLABSI. The longer patients have a central line, the higher the risk of them getting a CLABSI.

Why do we measure this rate of infection?

Our goal is to never have a bloodstream infection. We measure the rate of bloodstream infections from a central line to be able to find ways to prevent them in the future. Our goal is to reduce infection rates, reduce potential complications for our patients and ultimately help kids get better faster.

How has the Heart Institute at Children's Colorado been able to reduce these infections?

We have a number of projects in place to reduce the possibility of an infection, including:

  • Using antibiotics before an operation
  • Following best practices for inserting and taking care of central lines
  • Working with colleagues throughout the nation to develop best practices and learn from each other

We are constantly improving our performance as one of the best pediatric cardiology hospitals

We continue to improve the safety and quality of care throughout the Heart Institute through thoughtful and persistent monitoring. In addition to requiring quality metrics from each team within the Heart Institute, we perform weekly safety walk-arounds, which help parents and staff have a voice in directing improvement initiatives.

  • In 2018, the rate of skin injury (> stage II injury) in both our Cardiac Intensive Care Unit (CICU) and our Cardiac Progressive Care Unit was less than 1 per 1,000 patient days.  This year we are transitioning this care metric to include stage II skin injury to ensure that we are constantly detecting ways to decrease skin injury.
  • We continue to provide excellent nutrition and closely monitor all of our patients' nutritional health to ensure your child consistently receives the best diet. We have protocols in place to ensure safe transition to oral feeds.
  • We measure our daily care bundles and report our compliance to our team and hospital leaders weekly. This helps prevent hospital acquired illness.
  • From 2017 to 2018, we successfully decreased the incidence of peripheral intravenous therapy (peripheral IV or PIV)-related injuries from 1.71 to 0.99 per 100 line days.

Additional information about quality at the Heart Institute

If you have any questions about this information, please don't hesitate to contact us by calling 720-777-SAFE. Or, visit the links below for even more resources for heart parents:

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