Technical performance score is associated with outcomes after the Norwood procedure. J Thorac Cardiovasc Surg 2014 Nov;148(5):2208-13, 2214.e1-6
Date
07/20/2014Pubmed ID
25037617Pubmed Central ID
PMC4253672DOI
10.1016/j.jtcvs.2014.05.076Scopus ID
2-s2.0-84911006020 (requires institutional sign-in at Scopus site) 46 CitationsAbstract
OBJECTIVES: The technical performance score (TPS) has been reported in a single center study to predict the outcomes after congenital cardiac surgery. We sought to determine the association of the TPS with outcomes in patients undergoing the Norwood procedure in the Single Ventricle Reconstruction trial.
METHODS: We calculated the TPS (class 1, optimal; class 2, adequate; class 3, inadequate) according to the predischarge echocardiograms analyzed in a core laboratory and unplanned reinterventions that occurred before discharge from the Norwood hospitalization. Multivariable regression examined the association of the TPS with interval to first extubation, Norwood length of stay, death or transplantation, unplanned postdischarge reinterventions, and neurodevelopment at 14 months old.
RESULTS: Of 549 patients undergoing a Norwood procedure, 356 (65%) had an echocardiogram adequate to assess atrial septal restriction or arch obstruction or an unplanned reintervention, enabling calculation of the TPS. On multivariable regression, adjusting for preoperative variables, a better TPS was an independent predictor of a shorter interval to first extubation (P=.019), better transplant-free survival before Norwood discharge (P<.001; odds ratio, 9.1 for inadequate vs optimal), shorter hospital length of stay (P<.001), fewer unplanned reinterventions between Norwood discharge and stage II (P=.004), and a higher Bayley II psychomotor development index at 14 months (P=.031). The TPS was not associated with transplant-free survival after Norwood discharge, unplanned reinterventions after stage II, or the Bayley II mental development index at 14 months.
CONCLUSIONS: TPS is an independent predictor of important outcomes after Norwood and could serve as a tool for quality improvement.
Author List
Nathan M, Sleeper LA, Ohye RG, Frommelt PC, Caldarone CA, Tweddell JS, Lu M, Pearson GD, Gaynor JW, Pizarro C, Williams IA, Colan SD, Dunbar-Masterson C, Gruber PJ, Hill K, Hirsch-Romano J, Jacobs JP, Kaltman JR, Kumar SR, Morales D, Bradley SM, Kanter K, Newburger JW, Pediatric Heart Network InvestigatorsAuthor
Peter C. Frommelt MD Adjunct Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Chi-Square DistributionChild Development
Databases, Factual
Decision Support Techniques
Echocardiography
Heart Defects, Congenital
Heart Transplantation
Humans
Infant
Kaplan-Meier Estimate
Length of Stay
Multivariate Analysis
Neuropsychological Tests
North America
Norwood Procedures
Odds Ratio
Postoperative Complications
Predictive Value of Tests
Proportional Hazards Models
Psychomotor Performance
Quality Improvement
Quality Indicators, Health Care
Reoperation
Reproducibility of Results
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome