UNC and Duke should unite on pediatric heart surgery

A recent New York Times report on problems with pediatric heart surgery at UNC Children’s Hospital showed administrators were reluctant to respond to concerns raised by UNC cardiologists. UNC should not be equally reluctant to accept help from the outside.

UNC Children’s Hospital should merge its pediatric heart surgery program with the same work being done at Duke Health’s Children’s Hospital, just 10 miles away. A common program would greatly enhance the treatment of children and babies in need of complex heart surgery.

As it is, UNC Children’s does 100 to 150 pediatric heart surgeries a year, a rate considered low volume. That makes it harder to recruit and retain surgeons and limits surgeons ability to hone their skills. It also makes it harder to maintain the other parts of the program, cardiologists, anesthesiologists and staff for a pediatric heart intensive care unit.

East Carolina University’s hospital faced similar challenges as it provided pediatric heart surgery at a low-volume level of 50 to 75 surgeries a year. Eighteen months ago, ECU started sending all its pediatric heart surgery patients to Duke. The change helped boost Duke’s volume to where it has done more than 800 surgeries in 18 months. During the same period, Duke has posted a 1 percent mortality rate, despite a caseload in which a third of the operations are high risk.

Unfortunately, UNC Children’s Hospital appears uninterested in combining resources despite overtures from Duke. In a statement Thursday, the hospital said, “While there have been discussions with Duke Health over the years about ways to collaborate across various pediatric specialties, there are no plans to combine our programs. Patients in this region benefit from having two world-class medical institutions located so close together. Our clinicians frequently collaborate with colleagues at Duke. We sometimes transfer patients to them and vice versa.”

Meanwhile, UNC dismisses the poor surgical outcomes shown in the New York Times report as problems related to personnel, not low volume. In a News & Observer op-ed Sunday, two of UNC Children’s leaders, Dr. Melina Kibbe, chair of the Department of Surgery, and Dr. Stephanie Duggins Davis, chair of the Department of Pediatrics, said that The New York Times focused on a 2016-2017 time period, but the issues have since cleared up. They wrote: “Turnover and new leadership have fully addressed those issues, and the current success of the program is unprecedented.”

Such assurances are not being taken at face value. The state Department of Health and Human Services opened an investigation of UNC Children’s immediately after the newspaper report appeared last week. It is a joint review by the state and the U.S. Centers for Medicare and Medicaid Services. Medicaid pays for the care of more than half of UNC Children’s heart surgery patients.

Mark Benton, DHHS’s deputy secretary for health services, said of the investigation, “There are things we want to know. It’s important that there are policies and procedures in place to ensure that if something bad happened, it won’t happen again.”

UNC Children’s would prefer to run its own pediatric heart surgery program as a matter of institutional pride and money — the most complex operations can cost a half-million dollars. But pride and money aren’t — or shouldn’t be — the primary concerns. What matters most is how to get the best care for children in this highly specialized and high-stakes area of medicine. To do that, North Carolina’s best hospitals should combine their resources and expertise.