World and Nation

Pediatric Heart Surgery on Hold at Massachusetts General Hospital

Massachusetts General Hospital has suspended its pediatric cardiac surgery program after two babies recently suffered serious complications following errors made during open-heart surgery.

The Harvard teaching hospital had expanded the small program and taken on more complex cases after hiring a heart surgeon two years ago to operate solely on children. But that plan has not worked out as hoped, and hospital executives said they shut down the program last week, at least temporarily. State public health officials began investigating the two cases after Mass. General notified them on Tuesday that the hospital had stopped taking young heart surgery patients and was evaluating whether to reopen the program.

Dr. David Torchiana, head of the Massachusetts General Physicians Organization, said both babies survived their operations, although one suffered neurological damage. That child, who was operated on at the end of January, has since been transferred to Children’s Hospital Boston. The second infant had surgery in March and is still at Mass. General and recovering well, Torchiana said. In both cases, technical errors were made during the surgeries, Torchiana said, though he declined to go into detail because of what he called patient privacy concerns.

The hospital’s decision to expand its program, and now to suspend it, goes to the core of a long-standing debate in pediatric medicine: should hospitals run small surgery programs or should care be consolidated in a few large programs, where physicians and nurses can sharpen their skills by caring for large numbers of patients? In Boston, Children’s Hospital operates on the hearts of about 1,100 babies and children a year, making it the largest pediatric heart surgery program in the country, officials there said. Mass. General performed 90 pediatric heart surgeries in the last 20 months, while Tufts Medical Center did 24 last year.

State health officials recommend a minimum 300 cases annually for hospitals to operate adult heart surgery programs, but they do not set a standard for pediatric heart surgery.

Dr. Peter Manning, director of cardiothoracic surgery at Cincinnati Children’s Hospital Medical Center, said that while the research is not conclusive, there is some evidence that quality is more variable in small programs than in larger ones.

But, he said, it’s hard for regulators to push small programs to close because the data are not conclusive; some small programs have achieved good results, usually in part by referring some of the most complex cases to major centers. And, Manning added, cardiac surgery can be lucrative and prestigious for hospitals, making the programs especially desirable. Mass. General’s “numbers are pretty small,” Manning said. “When you get below 100 cases you really worry that, unless they’re pretty straightforward, whether the ((surgeon)) is doing enough to keep their skills up.” He said it may have been “very wise to close the program.”

Mass. General has had a pediatric heart surgery program since the 1960s.