Technical performance score is associated with outcomes after the Norwood procedure

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 148; no. 5; pp. 2208 - 2214.e6
• Main Authors: Nathan, Meena, MD, Sleeper, Lynn A., ScD, Ohye, Richard G., MD, Frommelt, Peter C., MD, Caldarone, Christopher A., MD, Tweddell, James S., MD, Lu, Minmin, MS, Pearson, Gail D., MD, ScD, Gaynor, J. William, MD, Pizarro, Christian, MD, Williams, Ismee A., MD, MS, Colan, Steven D., MD, Dunbar-Masterson, Carolyn, BSN, RN, Gruber, Peter J., MD, Hill, Kevin, MD, Hirsch-Romano, Jennifer, MD, Jacobs, Jeffrey P., MD, Kaltman, Jonathan R., MD, Kumar, S. Ram, MD, PhD, Morales, David, MD, Bradley, Scott M., MD, Kanter, Kirk, MD, Newburger, Jane W., MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2014
• Subjects: Cardiothoracic Surgery; Chi-Square Distribution; Child Development; Databases, Factual; Decision Support Techniques; Echocardiography; Heart Defects, Congenital - diagnosis; Heart Defects, Congenital - mortality; Heart Defects, Congenital - surgery; Heart Transplantation; Humans; Infant; Kaplan-Meier Estimate; Length of Stay; Multivariate Analysis; Neuropsychological Tests; North America; Norwood Procedures - adverse effects; Norwood Procedures - mortality; Norwood Procedures - standards; Odds Ratio; Postoperative Complications - mortality; Postoperative Complications - therapy; Predictive Value of Tests; Proportional Hazards Models; Psychomotor Performance; Quality Improvement - standards; Quality Indicators, Health Care - standards; Reoperation; Reproducibility of Results; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; North America; pulmonary artery; mental developmental index; IQR; interquartile range; psychomotor developmental index; SVR; LOS; PA; ASD; MDI; PDI; single ventricle reconstruction; TPS; technical performance score; length of stay; atrial septal defect; 20
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2014.05.076

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.