Stage I Norwood: optimal technical performance improves outcomes irrespective of preoperative physiologic status or case complexity
Open accessAbstract
Objective Interplay of baseline physiologic status, case complexity, technical performance, and outcomes in high-acuity operations has been poorly defined. This study explored these interactions to determine whether a technically optimal operation can mitigate effects of baseline physiology and high case-complexity on outcomes for the stage I Norwood procedure.Methods Technical performance was categorized as optimal, adequate, or inadequate from adequacy of the anatomic repair of the stage I subprocedures according to anatomic areas where intervention is performed. Physiological illness severity statuses in preoperative and postoperative periods were determined with Pediatric Risk of Mortality III system, which uses 17 physiologic variables. Case complexity was calculated with Aristotle comprehensive system. All patients undergoing stage I procedure from January 2004 to December 2007 were retrospectively studied.Results One hundred thirty-five procedures were included. Five were excluded from the technical performance assessment because of inadequate postoperative data. Eighty-one (62.3%), 26 (20%), and 23 (17.7%), respectively, were scored as optimal, adequate, and inadequate. Overall hospital mortality was 14.1%. Inadequate technical performance, high-complexity Aristotle comprehensive scores, and high preoperative illness severity scores correlated with significantly higher hospital mortality, longer stay, and greater frequency of major postoperative complications. In subgroup analysis of patients with optimal technical performance, outcomes were favorable irrespective of high or low preoperative physiologic illness severity or case complexity.Conclusions In stage I Norwood procedures, optimal technical performance attenuated effects of poor preoperative physiologic status and high case complexity, with reduced hospital mortality. Inadequate technical performance resulted in poor outcomes regardless of preoperative status.
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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 [17]
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- Authors
- Karamichalis, J. M., Thiagarajan, R. R., Liu, H., Mamic, P., Gauvreau, K., & Bacha, E. A.
- Affiliations
- Boston Children's Hospital (US)
- Harvard University (US)
- Corresponding author
- Bacha, Emile A.
- ORCID
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2010-04
- Volume
- 139
- Issue
- 4
- Pages
- 962-968
- ISSN
- 0022-5223 (ISSN-L)
- OpenAlex
- W2104463581
- Cited by
- 46
- References
- 14
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 2 · 2023: 2 · 2021: 2 · 2020: 4 · 2019: 1 · 2018: 2 · 2017: 1 · 2016: 3 · 2014: 6 · 2013: 8 · 2012: 4
- FWCI
- 4.42
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Children's Heart Foundation
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Keywords
- hypoplastic left heart syndrome, case complexity, in-hospital mortality, postoperative complications, length of hospital stay, congenital heart surgery outcomes
- MeSH terms
- Heart Defects, Congenital, Humans, Infant, Infant, Newborn, Retrospective Studies, Severity of Illness Index, Cardiovascular Surgical Procedures, Treatment Outcome, Hospital Mortality, Risk Assessment
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