Revisiting the utility of technical performance scores following tetralogy of Fallot repair

Daud Lodin, Orestes Mavrothalassitis, Kim Haberer, Sherzana Sunderji, Ruben G.W. Quek, Shabnam Peyvandi, Anita Moon-Grady, Tara Karamlou

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective Although an important quality metric, current technical performance scores may not be generalizable and may omit operative factors that influence outcomes. We examined factors not included in current technical performance scores that may contribute to increased postoperative length of stay, major complications, and cost after primary repair of tetralogy of Fallot. Methods This is a retrospective single site study of patients younger than age 2 years with tetralogy of Fallot undergoing complete repair between 2007 and 2015. Medical record data and discharge echocardiograms were reviewed to ascertain component and composite technical performance scores. Primary outcomes included postoperative length of stay, major complications, and total hospital costs. Multivariable logistic and linear regression identified determinants of each outcome. Results Patient population (n = 115) had a median postoperative length of stay of 8 days (interquartile range, 6-10 days), and a median total cost of $71,147. Major complications occurred in 33 patients (29%) with 1 death. Technical performance scores assigned were optimum in 28 patients (25%), adequate in 59 patients (52%), and inadequate in 26 patients (23%). Neither technical performance score components nor composite scores were associated with increased postoperative length of stay. Optimum or adequate repairs versus inadequate had equal risk of a complication (P =.79), and equivalent mean total cost ($100,000 vs $187,000; P =.25). Longer cardiopulmonary bypass time per 1-minute increase (P <.01) was associated with longer postoperative length of stay and reintervention (P =.02). The need to return to bypass also increased total cost (P <.01). Conclusions Current tetralogy of Fallot technical performance scores were not associated with selected outcomes in our postoperative population. Although returning to bypass and bypass length are not included as components in the current score, these are important factors influencing complications and resource use in our population. Revisions anticipated from a prospective trial should consider including these variables.

Original languageEnglish (US)
Pages (from-to)585-595.e3
JournalJournal of Thoracic and Cardiovascular Surgery
Volume154
Issue number2
DOIs
StatePublished - Aug 1 2017
Externally publishedYes

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Tetralogy of Fallot
Length of Stay
Costs and Cost Analysis
Population
Hospital Costs
Cardiopulmonary Bypass
Medical Records
Linear Models
Logistic Models

Keywords

  • congenital
  • outcomes
  • quality

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Revisiting the utility of technical performance scores following tetralogy of Fallot repair. / Lodin, Daud; Mavrothalassitis, Orestes; Haberer, Kim; Sunderji, Sherzana; Quek, Ruben G.W.; Peyvandi, Shabnam; Moon-Grady, Anita; Karamlou, Tara.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 154, No. 2, 01.08.2017, p. 585-595.e3.

Research output: Contribution to journalArticle

Lodin, D, Mavrothalassitis, O, Haberer, K, Sunderji, S, Quek, RGW, Peyvandi, S, Moon-Grady, A & Karamlou, T 2017, 'Revisiting the utility of technical performance scores following tetralogy of Fallot repair', Journal of Thoracic and Cardiovascular Surgery, vol. 154, no. 2, pp. 585-595.e3. https://doi.org/10.1016/j.jtcvs.2017.02.066
Lodin, Daud ; Mavrothalassitis, Orestes ; Haberer, Kim ; Sunderji, Sherzana ; Quek, Ruben G.W. ; Peyvandi, Shabnam ; Moon-Grady, Anita ; Karamlou, Tara. / Revisiting the utility of technical performance scores following tetralogy of Fallot repair. In: Journal of Thoracic and Cardiovascular Surgery. 2017 ; Vol. 154, No. 2. pp. 585-595.e3.
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abstract = "Objective Although an important quality metric, current technical performance scores may not be generalizable and may omit operative factors that influence outcomes. We examined factors not included in current technical performance scores that may contribute to increased postoperative length of stay, major complications, and cost after primary repair of tetralogy of Fallot. Methods This is a retrospective single site study of patients younger than age 2 years with tetralogy of Fallot undergoing complete repair between 2007 and 2015. Medical record data and discharge echocardiograms were reviewed to ascertain component and composite technical performance scores. Primary outcomes included postoperative length of stay, major complications, and total hospital costs. Multivariable logistic and linear regression identified determinants of each outcome. Results Patient population (n = 115) had a median postoperative length of stay of 8 days (interquartile range, 6-10 days), and a median total cost of $71,147. Major complications occurred in 33 patients (29{\%}) with 1 death. Technical performance scores assigned were optimum in 28 patients (25{\%}), adequate in 59 patients (52{\%}), and inadequate in 26 patients (23{\%}). Neither technical performance score components nor composite scores were associated with increased postoperative length of stay. Optimum or adequate repairs versus inadequate had equal risk of a complication (P =.79), and equivalent mean total cost ($100,000 vs $187,000; P =.25). Longer cardiopulmonary bypass time per 1-minute increase (P <.01) was associated with longer postoperative length of stay and reintervention (P =.02). The need to return to bypass also increased total cost (P <.01). Conclusions Current tetralogy of Fallot technical performance scores were not associated with selected outcomes in our postoperative population. Although returning to bypass and bypass length are not included as components in the current score, these are important factors influencing complications and resource use in our population. Revisions anticipated from a prospective trial should consider including these variables.",
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N2 - Objective Although an important quality metric, current technical performance scores may not be generalizable and may omit operative factors that influence outcomes. We examined factors not included in current technical performance scores that may contribute to increased postoperative length of stay, major complications, and cost after primary repair of tetralogy of Fallot. Methods This is a retrospective single site study of patients younger than age 2 years with tetralogy of Fallot undergoing complete repair between 2007 and 2015. Medical record data and discharge echocardiograms were reviewed to ascertain component and composite technical performance scores. Primary outcomes included postoperative length of stay, major complications, and total hospital costs. Multivariable logistic and linear regression identified determinants of each outcome. Results Patient population (n = 115) had a median postoperative length of stay of 8 days (interquartile range, 6-10 days), and a median total cost of $71,147. Major complications occurred in 33 patients (29%) with 1 death. Technical performance scores assigned were optimum in 28 patients (25%), adequate in 59 patients (52%), and inadequate in 26 patients (23%). Neither technical performance score components nor composite scores were associated with increased postoperative length of stay. Optimum or adequate repairs versus inadequate had equal risk of a complication (P =.79), and equivalent mean total cost ($100,000 vs $187,000; P =.25). Longer cardiopulmonary bypass time per 1-minute increase (P <.01) was associated with longer postoperative length of stay and reintervention (P =.02). The need to return to bypass also increased total cost (P <.01). Conclusions Current tetralogy of Fallot technical performance scores were not associated with selected outcomes in our postoperative population. Although returning to bypass and bypass length are not included as components in the current score, these are important factors influencing complications and resource use in our population. Revisions anticipated from a prospective trial should consider including these variables.

AB - Objective Although an important quality metric, current technical performance scores may not be generalizable and may omit operative factors that influence outcomes. We examined factors not included in current technical performance scores that may contribute to increased postoperative length of stay, major complications, and cost after primary repair of tetralogy of Fallot. Methods This is a retrospective single site study of patients younger than age 2 years with tetralogy of Fallot undergoing complete repair between 2007 and 2015. Medical record data and discharge echocardiograms were reviewed to ascertain component and composite technical performance scores. Primary outcomes included postoperative length of stay, major complications, and total hospital costs. Multivariable logistic and linear regression identified determinants of each outcome. Results Patient population (n = 115) had a median postoperative length of stay of 8 days (interquartile range, 6-10 days), and a median total cost of $71,147. Major complications occurred in 33 patients (29%) with 1 death. Technical performance scores assigned were optimum in 28 patients (25%), adequate in 59 patients (52%), and inadequate in 26 patients (23%). Neither technical performance score components nor composite scores were associated with increased postoperative length of stay. Optimum or adequate repairs versus inadequate had equal risk of a complication (P =.79), and equivalent mean total cost ($100,000 vs $187,000; P =.25). Longer cardiopulmonary bypass time per 1-minute increase (P <.01) was associated with longer postoperative length of stay and reintervention (P =.02). The need to return to bypass also increased total cost (P <.01). Conclusions Current tetralogy of Fallot technical performance scores were not associated with selected outcomes in our postoperative population. Although returning to bypass and bypass length are not included as components in the current score, these are important factors influencing complications and resource use in our population. Revisions anticipated from a prospective trial should consider including these variables.

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