Abstract 4354094: Using Mixed Methods Research to Address Stagnant Mortality Rates in Congenital Heart Surgery

Background: New perspectives are needed to break the stagnant 2.7% operative mortality rate in congenital cardiac surgery. After experiencing a 0% operative mortality rate for 365 days (06/2023 to 06/2024), we aimed to qualitatively identify institutional factors impacting operative mortality and compare to reasons for operative mortality. Research Questions: 1) What are the descriptive characteristics of patients with CHD who experienced an operative mortality in our single institution from January 2020 to June 2023? 2) What are the most prevalent reasons for operative mortalities seen at our institution? 3) How do staff describe institutional factors that impact operative mortality outcomes? 4) How do the reasons for operative mortality compare to how staff describe institutional factors that impact operative mortality outcomes? Methods: A mixed-methods study was conducted to compare quantitative and qualitative data. A total of 43 operative mortality records between January 2020-June 2023 were reviewed and the reasons for operative mortality were quantified. Semi-structured interviews were conducted to identify institutional factors influencing operative mortality. Data were compared by matching reasons for operative mortality to each of the qualitative themes. Results: Reasons for operative mortality were technical failure (n=19 [22%]) and intractable disease (n=19 [22%]), communication (n=18 [21%]), management strategy (n=15 [18%]) and decision-making (n=14 [16%]). Three qualitative themes were revealed: (1) Implementing Best Medical Practices, (2) Fostering Healthy Interpersonal Relationships, and (3) Building a Responsive Organizational Structure. Upon comparison of quantitative and qualitative data, the institutional factors encompassed by Theme 1 were most comparable when the reason for operative mortality was technical failure, intractable disease, management strategy, or decision-making), while factors within Theme 2 were most comparable when the reason was communication. Theme 3 was only related to one instance of operative mortality. Conclusions: Efforts to implement best medical practices are critical to improve operative mortality. A considerable effort should also be made to foster healthy relationships amongst staff. Building a responsive organizational structure may indirectly influence outcomes and should be further explored. Centers can adapt these findings to create future strategies that will improve operative mortality outcomes locally.