Department of Cardiac Surgery, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts, USA.
Ann Thorac Surg. 2012 Oct;94(4):1317-23; discussion 1323. doi: 10.1016/j.athoracsur.2012.05.014. Epub 2012 Jul 12.
Technical performance in congenital cardiac operations and its association with clinical outcomes was previously examined in infants and neonates. The purpose of this study was the development and implementation of a system for measuring technical performance in the majority of congenital cardiac operations to be used as a surgeon's self-assessment tool.
Using the methodologic framework piloted at our institution, measures of technical performance were created for more than 90% of all congenital cardiac operations. Each operation was divided into multiple subprocedures to be assessed separately. Criteria for technical scores were created using a consensus panel of senior clinicians and were based primarily on the predischarge echocardiographic findings and need for early postoperative reinterventions. This system of procedure modules was then piloted by prospectively assigning technical scores to all patients undergoing operations.
Thirty modules were created covering more than 90% of the cardiac operations performed. One hundred eighty-five patients were enlisted. One hundred one (54.6%) cases were scored as class 1 (highest), 46 (24.9%) cases as class 2, 22 (11.9%) cases as class 3 (lowest); 16 cases (8.6%) could not be scored. The results were further analyzed by RACHS (Risk Adjustment for Congenital Heart Surgery) categories and outcomes. Valve-procedure-specific criteria were calibrated to reflect specific echocardiographic measurements.
The development and implementation of a broad technical performance self-assessment system for congenital cardiac operations is possible. Based on this scoring system, the impact of a less than optimal (2 or 3) technical score depends on case risk category, with higher mortality in the higher risk group, and increased resource use for lower risk procedures.
先前在婴儿和新生儿中检查了先天性心脏手术的技术性能及其与临床结果的关系。本研究的目的是开发和实施一种用于测量大多数先天性心脏手术技术性能的系统，作为外科医生的自我评估工具。
使用我们机构试点的方法学框架，为超过 90%的所有先天性心脏手术创建了技术性能指标。将每个手术分为多个子程序进行单独评估。技术评分标准是使用资深临床医生的共识小组创建的，主要基于出院前超声心动图检查结果和对术后早期再次干预的需求。然后，通过前瞻性地为所有接受手术的患者分配技术评分，对该程序模块系统进行试点。
创建了 30 个模块，涵盖了超过 90%的心脏手术。共有 185 名患者入组。101 例（54.6%）评为 1 级（最高），46 例（24.9%）评为 2 级，22 例（11.9%）评为 3 级（最低）；16 例（8.6%）无法评分。然后根据 RACHS（先天性心脏病手术风险调整）类别和结果对结果进行了进一步分析。瓣膜手术特定标准进行了校准，以反映特定的超声心动图测量值。
为先天性心脏手术开发和实施广泛的技术性能自我评估系统是可行的。根据该评分系统，评分低于理想水平（2 或 3）的影响取决于病例风险类别，高风险组的死亡率更高，低风险手术的资源利用率更高。
