Abstract 220: Technical Performance Scores Predict Outcomes Following Congenital Heart Surgery: Multicenter Validation

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Meena Nathan ◽  
Hua Liu ◽  
Steven D Colan ◽  
Lazaros Kochilas ◽  
Geetha Raghuveer ◽  
...  
Keyword(s):  
Adverse Events ◽  
Hospital Stay ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Assessment Tool ◽  
Multivariable Analysis ◽  
Congenital Heart Surgery ◽  
Hospital Length Of Stay ◽  
Atrioventricular Canal ◽  
Technical Performance

BACKGROUND: In previous work from a single center, Technical Performance Score (TPS), a tool that assesses technical adequacy of repair, has been shown to be strongly associated with outcomes in congenital cardiac surgery. We sought to validate the efficacy of TPS in a multicenter environment. METHODS: All patients (1 day to 62 years) who were discharged from January 1 to December 31, 2011; and who underwent 9 congenital cardiac procedures (Arterial switch operation [84], Bidirectional Glenn [75], Atrioventricular canal repair [135], Fontan [97], Arch repair on pump [58], Stage I Procedure [85], Pulmonary valve replacement [116], Tetralogy of Fallot repair [112], and Ventricular septal defect repair [163]); from 5 centers were included. Based on echocardiograms (echo) prior to discharge or death, and unplanned reinterventions at surgical site; TPS was assigned using previously established criteria. Case complexity was determined by RACHS-1 category. Outcomes included (a) major postoperative adverse events (AE) excluding unplanned reinterventions, (b) length of ventilation, and (c) postoperative hospital stay. Adjusted analysis used logistic/linear regression to determine odds ratio (OR) and regression coefficient (b) for each outcome. RESULTS: There were 925 hospital discharges: 418 (45%) were RACHS-1 category 2, 295 (32%) category 3, 85 (9%) category 4, 86 (9%) category 6 and the cohort included 41 (4%) adults. TPS were as follows: 491 (53%) class 1-optimal, 263 (28%) class 2-adequate, 131 (14%) class 3-inadequate and 40 (4%) had no TPS assigned because of a lack of or incomplete echos (NA). There were 26 (2.8%) deaths (81% of deaths were in class 3) and 105 (11%) adverse events. Occurrence of major adverse events, ventilation time and hospital length of stay were all significantly higher in class 3 (Figure). On multivariable analysis adjusting for age, RACHS-1, prematurity, and presence of non-cardiac anomalies; Class 3 TPS was associated with a higher odds of AE (OR 7.4, CI 4.1-13.2, p<0.001), longer ventilation (b 1.9, CI 1.6-2.2, p<0.001), and hospital stay (b 1.6, CI 1.4 to 1.8, p<0.001). CONCLUSION: TPS predicts outcomes after congenital heart surgery in a multicenter cohort, and can serve as quality assessment tool. Outcomes may be favorably influenced by focusing on technical excellence.

Abstract 113: Technical Performance Scores as a quality assessment tool in Congenital Heart Surgery; preliminary analysis of validation data

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Meena Nathan ◽  
John Karamichalis ◽  
Steven Colan ◽  
Hua Liu ◽  
John E Mayer ◽  
...  
Keyword(s):  
Adverse Events ◽  
Quality Assessment ◽  
Scoring System ◽  
Heart Surgery ◽  
Assessment Tool ◽  
Congenital Heart Surgery ◽  
Quality Assessment Tool ◽  
Validation Data ◽  
Technical Performance ◽  
Class 1

BACKGROUND : In previous work from our institution, individual practitioner technical performance of surgical procedures has been shown to be an important contributor to outcome and resource utilization in selected congenital cardiac operations. We have developed a Technical Scoring System for evaluation of majority of congenital cardiac procedures and wish to validate its efficacy as a self assessment tool for quality improvement. METHODS : All patients who were discharged between Jan 1 2011 and Dec 31, 2011 were included in this study. Based on discharge echocardiograms, a technical performance score was assigned using previously designed criteria. Case complexity was determined by RACHS-I category, postoperative adverse events and mortality were prospectively monitored. Outcomes were analyzed by non parametric methods. RESULTS : There were a total of 842 discharges encompassing all ages from neonates to adults. 560 (67%) were in RACHS-1 categories 1 to 3 (low risk) and 130 (15%) were in RACHS-1 categories 4 to 6 (high risk) and 152 (18%) could not be categorized. Technical performance scores were as follows: 436 (52%) class 1-optimal, 242(29%) class 2-adequate, 96 (115) class 3-inadequate, and 68(8%) could not classified. Occurrence of major adverse events, mortality and length of stay were all significantly higher in class 3. CONCLUSION : Preliminary data validates the usefulness of the technical scoring system as a quality assessment tool.

Reducing readmissions following paediatric cardiothoracic surgery: a quality improvement initiative

2014 ◽  
Vol 25 (5) ◽  
pp. 935-940 ◽  
Author(s):  
Brian Kogon ◽  
Kim Woodall ◽  
Kirk Kanter ◽  
Bahaaldin Alsoufi ◽  
Matt Oster
Keyword(s):  
Risk Factors ◽  
Hospital Stay ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Failure To Thrive ◽  
Congenital Heart Surgery ◽  
Cardiothoracic Surgery ◽  
Hispanic Ethnicity ◽  
Multivariate Risk ◽  
Initial Hospital

AbstractBackground: We have previously identified risk factors for readmission following congenital heart surgery – Hispanic ethnicity, failure to thrive, and original hospital stay more than 10 days. As part of a quality initiative, changes were made to the discharge process in hopes of reducing the impact. All discharges were carried out with an interpreter, medications were delivered to the hospital before discharge, and phone calls were made to families within 72 hours following discharge. We hypothesised that these changes would decrease readmissions. Methods: The current cohort of 635 patients underwent surgery in 2012. Demographic, preoperative, operative, and postoperative variables were evaluated. Univariate and multivariate risk factor analyses were performed. Comparisons were made between the initial (2009) and the current (2012) cohorts. Results: There were 86 readmissions of 77 patients during 2012. Multivariate risk factors for readmission were risk adjustment for congenital heart surgery score and initial hospital stay >10 days. In comparing 2009 with 2012, the overall readmission rate was similar (10 versus 12%, p=0.27). Although there were slight decreases in the 2012 readmissions for those patients with Hispanic ethnicity (18 versus 16%, p=0.79), failure to thrive (23 versus 17%, p=0.49), and initial hospital stay >10 days (22 versus 20%, p=0.63), they were not statistically significant. Conclusions: Potential risk factors for readmission following paediatric cardiothoracic surgery have been identified. Although targeted modifications in discharge processes can be made, they may not reduce readmissions. Efforts should continue to identify modifiable factors that can reduce the negative impact of hospital readmissions.

scholarly journals The Congenital Heart Technical Skill Study: Rationale and Design

2019 ◽  
Vol 10 (2) ◽  
pp. 137-144 ◽  
Author(s):  
Brett R. Anderson ◽  
S. Ram Kumar ◽  
Danielle Gottlieb-Sen ◽  
Matthew H. Liava’a ◽  
Kevin D. Hill ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Heart Surgery ◽  
Technical Skills ◽  
Congenital Heart Surgery ◽  
Outcome Data ◽  
Technical Skill ◽  
Video Observation ◽  
Atrioventricular Canal ◽  
Evaluation Protocol ◽  
Interclass Correlation

Background: We report the rationale and design for a peer-evaluation protocol of attending congenital heart surgeon technical skill using direct video observation. Methods: All surgeons contributing data to The Society of Thoracic Surgeons—Congenital Heart Surgery Database (STS-CHSD) are invited to submit videos of themselves operating, to rate peers, or both. Surgeons may submit Norwood procedures, complete atrioventricular canal repairs, and/or arterial switch operations. A HIPPA-compliant website allows secure transmission/evaluation. Videos are anonymously rated using a modified Objective Structured Assessment of Technical Skills score. Ratings are linked to five years of contemporaneous outcome data from the STS-CHSD and surgeon questionnaires. The primary outcome is a composite for major morbidity/mortality. Results: Two hundred seventy-six surgeons from 113 centers are eligible for participation: 83 (30%) surgeons from 53 (45%) centers have agreed to participate, with recruitment ongoing. These surgeons vary considerably in years of experience and outcomes. Participants, both early and late in their careers, describe the process as “very rewarding” and “less time consuming than anticipated.” An initial subset of 10 videos demonstrated excellent interrater reliability (interclass correlation = 0.85). Conclusions: This study proposes to evaluate the technical skills of attending pediatric cardiothoracic surgeons by video observation and peer-review. It is notable that over a quarter of congenital heart surgeons, across a range of experiences, from almost half of United States centers have already agreed to participate. This study also creates a mechanism for peer feedback; we hypothesize that feedback could yield broad and meaningful quality improvement.

Technical Performance Score Predicts Perioperative Outcomes in Complex Congenital Heart Surgery Performed in a Small-to-Medium-Volume Program

2019 ◽  
Vol 41 (1) ◽  
pp. 88-93
Author(s):  
Entela B. Lushaj ◽  
Heather L. Bartlett ◽  
Luke J. Lamers ◽  
Shannon Arndt ◽  
Joshua Hermsen ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Perioperative Outcomes ◽  
Performance Score ◽  
Technical Performance

scholarly journals Single center experience on dosing and adverse events of recombinant factor seven use for bleeding after congenital heart surgery

2015 ◽  
Vol 27 (1) ◽  
pp. 18-22 ◽  
Author(s):  
Mustafa Kurkluoglu ◽  
Alyson M. Engle ◽  
John P. Costello ◽  
Narutoshi Hibino ◽  
David Zurakowski ◽  
...  
Keyword(s):  
Adverse Events ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Single Center ◽  
Single Center Experience

Abstract 4570: Association Between Intra-operative and Early Postoperative Glucose Levels and Adverse Outcomes Following Complex Congenital Heart Surgery

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Angelo Polito ◽  
Ravi R Thigarajan ◽  
Peter C Laussen ◽  
Kimberlee Gauvreau ◽  
Michael S Agus ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Glucose Control ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Composite Endpoint ◽  
Congenital Heart Surgery ◽  
Adverse Outcomes ◽  
Hospital Length Of Stay ◽  
Glucose Levels ◽  
Multiple Variables

Although hyperglycemia is associated with increased mortality in critically ill adults, studies in children undergoing cardiac surgery are limited and have reached conflicting conclusions. We sought to determine whether associations exist between perioperative glucose exposure, prolonged hospitalization and morbid events following complex congenital heart surgery. Metrics of glucose control including average, peak, minimum and standard deviation of glucose levels, and duration of hyperglycemia (hours >126 mg/dL and 200 mg/dL) were determined intraoperatively and for 72 hours following surgery for 378 consecutive children who had a Risk Adjustment in Congenital Heart Surgery-1 category ≥3. Regression analyses were used to determine relationships between glucose variables, hospital length of stay and a composite morbidity-mortality outcome (death, ECMO, infection, hepatic injury, renal failure, and/or brain injury) after controlling for multiple variables known to influence early outcomes. Intraoperatively, a minimum glucose ≤75 mg/dL was associated with greater adjusted odds of reaching the composite morbidity-mortality endpoint (odds ratio [OR], 3.10; 95% confidence interval [CI], 1.49 – 6.48), but other metrics of glucose control were not associated with the composite endpoint or length of stay. Greater duration of hyperglycemia (glucose >126 mg/dl) during the first 72 postoperative hours was associated with longer duration of hospitalization (p<0.001). In the 72 hours after surgery, average glucose <110 mg/dl (OR, 7.30; 95% CI, 1.95–27.25) or >143 mg/dl (OR, 5.21, 95% CI, 1.37–19.89), minimum glucose ≤75 mg/dL (OR, 2.85, 95% CI, 1.38 –5.88), and peak glucose level ≥250 mg/dl (OR, 2.55, 95% CI, 1.20 –5.43) were all associated with greater adjusted odds of reaching the composite morbidity-mortality endpoint. In children undergoing complex congenital heart surgery, intraoperative hyperglycemia was not associated with adverse outcomes. When considering analyses of several metrics of glucose control, the optimal postoperative glucose range may be 110 –126 mg/dl. A randomized trial of strict glycemic control achieved with insulin infusions in this patient population is needed.

Alpha-blockade during congenital heart surgery admissions: analysis from national database

2021 ◽  
pp. 1-7
Author(s):  
Brian Lee ◽  
Enrique G. Villarreal ◽  
Emad B. Mossad ◽  
Jacqueline Rausa ◽  
Ronald A. Bronicki ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Univariate Analysis ◽  
Congenital Heart Surgery ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Icu Length Of Stay ◽  
Alpha Blockade ◽  
Stay Hospital

Abstract Introduction: The effects of alpha-blockade on haemodynamics during and following congenital heart surgery are well documented, but data on patient outcomes, mortality, and hospital charges are limited. The purpose of this study was to characterise the use of alpha-blockade during congenital heart surgery admissions and to determine its association with common clinical outcomes. Materials and Methods: A cross-sectional study was conducted using the Pediatric Health Information System database. De-identified data for patients under 18 years of age with a cardiac diagnosis who underwent congenital heart surgery were obtained from 2004 to 2015. Patients were subdivided on the basis of receiving alpha-blockade with either phenoxybenzamine or phentolamine during admission or not. Continuous and categorical variables were analysed using Mann−Whitney U-tests and Fisher exact tests, respectively. Characteristics between subgroups were compared using univariate analysis. Regression analyses were conducted to determine the impact of alpha-blockade on ICU length of stay, hospital length of stay, billed charges, and mortality. Results: Of the 81,313 admissions, 4309 (5.3%) utilised alpha-blockade. Phentolamine was utilised in 4290 admissions. In univariate analysis, ICU length of stay, total length of stay, inpatient mortality, and billed charges were all significantly higher in the alpha-blockade admissions. However, regression analyses demonstrated that other factors were behind these increased. Alpha-blockade was significantly, independently associated with a 1.5 days reduction in ICU length of stay (p < 0.01) and a 3.5 days reduction in total length of stay (p < 0.01). Alpha-blockade was significantly, independently associated with a reduction in mortality (odds ratio 0.8, 95% confidence interval 0.7−0.9). Alpha-blockade was not independently associated with any significant change in billed charges. Conclusions: Alpha-blockade is used in a subset of paediatric cardiac surgeries and is independently associated with significant reductions in ICU length of stay, hospital length of stay, and mortality without significantly altering billed charges.

Reimbursement by current German Diagnosis-Related Groups system penalises complex congenital heart surgery

2013 ◽  
Vol 24 (2) ◽  
pp. 344-350 ◽  
Author(s):  
Nicodème Sinzobahamvya ◽  
Thorsten Kopp ◽  
Claudia Arenz ◽  
Hedwig C. Blaschczok ◽  
Viktor Hraska ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Hospital Stay ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Diagnosis Related Groups ◽  
Hospital Costs ◽  
Congenital Heart Surgery ◽  
German Diagnosis Related Groups ◽  
Complexity Score ◽  
Highly Correlated

AbstractA total of 458 hospital stays during the year 2011 were analysed to determine whether reimbursement by the current German Diagnosis-Related Groups system covers the costs incurred during hospital stay for congenital heart surgery. The costs of every hospital stay were estimated according to the guidelines of the Institute for the Hospital Remuneration System, an institute responsible for encoding hospital reimbursement in Germany. Cost-weight values of the year 2012 were applied for reimbursement. Related additional compensations were also included. Hospital costs ranged from 8896.26 to 193,671.94 euros per case, with a mean of 30,597 and standard deviation of 25,032 euros. Reimbursement varied from 8630.35 to 173,710.65 euros, with a mean of 25,514 and standard deviation of 18,497 euros: an underfunding of 17%. Fifty-nine per cent (271/458) of cases were classified, according to Aristotle complexity score, in higher comprehensive complexity: Levels 4–6. Costs highly correlated with complexity levels (Spearman's r coefficient = 0.89) and the regression was linear. Underfunding increased, linearly, from 6% for procedures with Level 1, lowest comprehensive complexity, to 23% for those with Level 6, highest complexity. In conclusion, this study demonstrates that reimbursement by the current German Diagnosis-Related Groups system increasingly penalises complex congenital heart surgery. Aristotle complexity score could help to correct this prejudicial situation.

Congenital Heart Surgery Nomenclature and Database Project: atrioventricular canal defect

2000 ◽  
Vol 69 (3) ◽  
pp. 36-43 ◽  
Author(s):  
Jeffrey P Jacobs ◽  
Redmond P Burke ◽  
James A Quintessenza ◽  
Constantine Mavroudis
Keyword(s):  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Atrioventricular Canal ◽  
Atrioventricular Canal Defect

scholarly journals Adverse Outcomes Prediction for Congenital Heart Surgery: A Machine Learning Approach

2021 ◽  
pp. 215013512110071
Author(s):  
Dimitris Bertsimas ◽  
Daisy Zhuo ◽  
Jack Dunn ◽  
Jordan Levine ◽  
Eugenio Zuccarelli ◽  
...  
Keyword(s):  
Machine Learning ◽  
Risk Factors ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Classification Trees ◽  
Congenital Heart Surgery ◽  
Assessment Tools ◽  
Hospital Length Of Stay ◽  
Total Quality ◽  
Optimal Classification

Objective: Risk assessment tools typically used in congenital heart surgery (CHS) assume that various possible risk factors interact in a linear and additive fashion, an assumption that may not reflect reality. Using artificial intelligence techniques, we sought to develop nonlinear models for predicting outcomes in CHS. Methods: We built machine learning (ML) models to predict mortality, postoperative mechanical ventilatory support time (MVST), and hospital length of stay (LOS) for patients who underwent CHS, based on data of more than 235,000 patients and 295,000 operations provided by the European Congenital Heart Surgeons Association Congenital Database. We used optimal classification trees (OCTs) methodology for its interpretability and accuracy, and compared to logistic regression and state-of-the-art ML methods (Random Forests, Gradient Boosting), reporting their area under the curve (AUC or c-statistic) for both training and testing data sets. Results: Optimal classification trees achieve outstanding performance across all three models (mortality AUC = 0.86, prolonged MVST AUC = 0.85, prolonged LOS AUC = 0.82), while being intuitively interpretable. The most significant predictors of mortality are procedure, age, and weight, followed by days since previous admission and any general preoperative patient risk factors. Conclusions: The nonlinear ML-based models of OCTs are intuitively interpretable and provide superior predictive power. The associated risk calculator allows easy, accurate, and understandable estimation of individual patient risks, in the theoretical framework of the average performance of all centers represented in the database. This methodology has the potential to facilitate decision-making and resource optimization in CHS, enabling total quality management and precise benchmarking initiatives.

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