Measurement of technical performance in surgery for congenital heart disease: the stage I Norwood procedure
Open accessAbstract
Objective No method of measuring technical performance exists for the stage I Norwood procedure. Hospital mortality is usually used as a surrogate for technical performance, but evidence is lacking to support this concept. A technical score was designed by expert consensus.Methods The technical score included the following steps: (1) Stage I was divided into subprocedures according to anatomic areas where an intervention is performed. (2) For each subprocedure, three score categories (optimal, adequate, and inadequate) were defined on the basis of echocardiography, catheterization, and/or clinical data. (3) Subprocedures were analyzed for the whole group and by surgeon. (4) Overall repair was also scored: optimal if all attempted subprocedures were optimal, inadequate if any was inadequate, and adequate for everything in between. (5) All patients undergoing the stage I procedure from January 2004 to December 2006 were retrospectively studied.Results One hundred ten patients were included (operated on by six surgeons), and 4 were excluded for lack of reliable postoperative data. Most subprocedures were scored as optimal. Subprocedures with the largest inadequate scores were distal arch reconstruction in 7 (6%) patients and aortopulmonary shunt in 3 (5%). No statistical differences were found among surgeons either by subprocedure or by overall outcome, although individual sample sizes were small. The overall score correlated with length of stay, extracorporeal membrane oxygenator support, and hospital mortality.Conclusions Technical performance can be measured after the stage I procedure, and performance score correlates with early outcome. This score may also be useful as a self-assessment tool.
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Patients with better technical performance scores have been shown to have improved clinical outcomes.
“Patients with superior technical performance scores have more favorable outcomes.”
From Utility of a standardized postcardiopulmonary bypass epicardial echocardiography protocol for stage I Norwood palliation: STERN et al. (2017) · cites this paper as [16]
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References 13 · Cited by 71
Research works printed but not linked: 2
- Vida V, Bacha EA, del Nido PJ, Mayer JE, Pigula FA, Tworetzky W, et al. Surgical outcome for patients with the MS-AA subtype of hypo- plastic left heart syndrome. J Thorac Cardiovasc Surg. JTCVS. 2008; 135:339-46.
- Institute of Medicine. Performance measurement: accelerating improve- ment. Washington [DC]: The National Academies Press; 2006.
- Authors
- Bacha, E. A., Larrazabal, L. A., Pigula, F. A., Gauvreau, K., Jenkins, K. J., Colan, S. D., Fynn-Thompson, F., Mayer, J. E., & del Nido, P. J.
- Affiliations
- Boston Children's Hospital (US)
- Corresponding author
- Bacha, Emile A.
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2008-10
- Volume
- 136
- Issue
- 4
- Pages
- 993-997.e2
- ISSN
- 0022-5223 (ISSN-L)
- OpenAlex
- W2000277125
- Cited by
- 71
- References
- 13
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 1 · 2023: 2 · 2022: 2 · 2020: 5 · 2019: 3 · 2018: 1 · 2017: 8 · 2016: 4 · 2015: 2 · 2014: 8 · 2013: 11 · 2012: 5
- FWCI
- 3.48
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Keywords
- congenital heart disease, technical performance, aortopulmonary shunt, surgeon variation, in-hospital mortality, length of hospital stay, expert consensus
- MeSH terms
- Clinical Competence, Female, Cardiac Surgical Procedures, Humans, Infant, Newborn, Length of Stay, Male, Palliative Care, Practice Patterns, Physicians', Probability, Prognosis, Retrospective Studies, Sensitivity and Specificity, Task Performance and Analysis, Cohort Studies, Survival Analysis, Treatment Outcome, Hospital Mortality, Risk Assessment, Heart Bypass, Right, Hypoplastic Left Heart Syndrome, Statistics, Nonparametric
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