Lushaj Entela B, Bartlett Heather L, Lamers Luke J, Arndt Shannon, Hermsen Joshua, Ralphe J Carter, Anagnostopoulos Petros V
Department of Surgery-Cardiothoracic, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
Department of Pediatrics-Cardiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
Pediatr Cardiol. 2020 Jan;41(1):88-93. doi: 10.1007/s00246-019-02226-9. Epub 2019 Nov 2.
As the quality of surgical outcomes depend on many factors, the development of validated tools to assess the different aspects of complex multidisciplinary teams' performance is crucial. The Technical Performance Score (TPS) has only been validated to correlate with outcomes in large-volume surgical programs. Here we assess the utility of TPS in correlation to perioperative outcomes for complex congenital heart surgeries (CHS) performed in a small-to-medium-volume program. 673 patients underwent CHS from 4/2012 to 12/2017 at our institution. Of those, 122 were STAT 4 and STAT 5. TPS was determined for each STAT 4 and STAT 5 operation using discharge echocardiogram: 1 = optimal, 2 = adequate, 3 = inadequate. Patient outcomes were compared including mortality, length of stay, ventilation times, and adverse events. 69 patients (57%) were neonates, 32 (26%) were infants, 17 (14%) were children, 4 (3%) were adults. TPS class 1 was assigned to 85 (70%) operations, TPS class 2 was assigned to 25 (20%) operations, and TPS class 3 was assigned to 12 (10%) operations. TPS was associated with re-intubation, ICU length of stay, postoperative length of stay, and mortality. TPS did not correlate with unplanned 30-day readmissions, need for reoperation, and inotropic score. Technical performance score was associated with perioperative outcomes and is a useful tool to assess the adequacy of repair for high complexity CHS in a small-to-medium-volume surgical program. TPS should be a part of program review in congenital heart programs of all sizes to identify strategies that may reduce postoperative morbidity and potentially improve long-term outcomes.
由于手术结果的质量取决于许多因素，因此开发经过验证的工具来评估复杂多学科团队绩效的不同方面至关重要。技术性能评分（TPS）仅在大规模手术项目中被验证与结果相关。在此，我们评估TPS与在中小型手术项目中进行的复杂先天性心脏病手术（CHS）围手术期结果的相关性。2012年4月至2017年12月期间，我们机构有673例患者接受了CHS手术。其中，122例为STAT 4和STAT 5。使用出院超声心动图为每例STAT 4和STAT 5手术确定TPS：1 = 最佳，2 = 足够，3 = 不足。比较患者的结果，包括死亡率、住院时间、通气时间和不良事件。69例（57%）为新生儿，32例（26%）为婴儿，17例（14%）为儿童，4例（3%）为成人。TPS 1级被分配给85例（70%）手术，TPS 2级被分配给25例（20%）手术，TPS 3级被分配给12例（10%）手术。TPS与再次插管、重症监护病房住院时间、术后住院时间和死亡率相关。TPS与计划外30天再入院、再次手术需求和肌力评分无关。技术性能评分与围手术期结果相关，是评估中小型手术项目中高复杂性CHS修复充分性的有用工具。TPS应成为所有规模先天性心脏病项目评估的一部分，以确定可能降低术后发病率并潜在改善长期结果的策略。
