Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts.
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts.
Ann Thorac Surg. 2023 Feb;115(2):471-477. doi: 10.1016/j.athoracsur.2022.04.051. Epub 2022 May 18.
The utility of the intraoperative technical performance score (IO-TPS) in predicting outcomes after congenital cardiac surgery remains unknown.
Data from patients undergoing surgery for congenital heart disease from January 2011 to December 2019 at a single institution were retrospectively reviewed. Intraoperative echocardiograms were used to assign IO-TPS for each index operation (class 1, no residua; class 2, minor residua; class 3, major residua). The primary outcome was a composite of in-hospital mortality, transplant, unplanned reintervention in the anatomic area of repair, and new permanent pacemaker implantation. Secondary outcomes included postdischarge (late) mortality or transplant and unplanned reintervention. Associations between IO-TPS and outcomes were assessed using logistic (primary) and Cox or competing risk (secondary) models, adjusting for preoperative patient- and procedure-related covariates.
The primary outcome was observed in 784 (11.5%) of 6793 patients who met entry criteria. On multivariable analysis, IO-TPS was a significant predictor of the primary outcome (class 2: odds ratio, 1.7 [95% CI, 1.4-2.0; P < .001]; class 3: odds ratio, 6.0 [95% CI, 4.0-8.9; P < .001]). Among 6661 transplant-free survivors of hospital discharge observed for up to 10.5 years, there were 185 (2.8%) deaths or transplants and 1171 (17.6%) reinterventions. Class 3 patients had a greater adjusted risk of late mortality or transplant (hazard ratio, 2.2; 95% CI, 1.2-4.2; P = .012) and late reintervention (subdistribution hazard ratio, 2.5; 95% CI, 1.8-3.3; P < .001) vs class 1 patients.
IO-TPS is significantly associated with adverse early and late outcomes after congenital heart surgery and may serve as an important adjunct for self-assessment and quality improvement.
术中技术表现评分（IO-TPS）在预测先天性心脏手术后结局方面的作用尚不清楚。
回顾性分析 2011 年 1 月至 2019 年 12 月在单中心接受先天性心脏病手术的患者数据。术中超声心动图用于为每个索引手术（1 级，无残余；2 级，轻度残余；3 级，重度残余）分配 IO-TPS。主要结局是院内死亡率、移植、解剖修复部位计划外再次介入以及新植入永久性起搏器的复合指标。次要结局包括出院后（晚期）死亡率或移植和计划外再次介入。使用逻辑（主要）和 Cox 或竞争风险（次要）模型评估 IO-TPS 与结局之间的关联，同时调整术前患者和手术相关的协变量。
符合纳入标准的 6793 例患者中有 784 例（11.5%）出现主要结局。多变量分析显示，IO-TPS 是主要结局的显著预测因素（2 级：比值比，1.7 [95%置信区间，1.4-2.0；P <.001]；3 级：比值比，6.0 [95%置信区间，4.0-8.9；P <.001]）。在 6661 例出院后无移植存活的患者中，观察到 185 例（2.8%）死亡或移植和 1171 例（17.6%）再次介入。3 级患者发生晚期死亡或移植（风险比，2.2 [95%置信区间，1.2-4.2；P =.012]）和晚期再次介入（亚分布风险比，2.5 [95%置信区间，1.8-3.3；P <.001]）的风险明显更高。
IO-TPS 与先天性心脏病手术后不良早期和晚期结局显著相关，可能是自我评估和质量改进的重要辅助手段。
