OBJECTIVE: Our objective was to define the relationship between surgical technical performance score, intraoperative adverse events, and major postoperative adverse events in complex pediatric cardiac repairs. METHOD: Infants younger than 6 months were prospectively followed up until discharge from the hospital. Technical performance scores were graded as optimal, adequate, or inadequate based on discharge echocardiograms and need for reintervention after initial surgery. Case complexity was determined by Risk Adjustment in Congenital Heart Surgery (RACHS-1) category, and preoperative illness severity was assessed by Pediatric Risk of Mortality (PRISM) III score. Intraoperative adverse events were prospectively monitored. Outcomes were analyzed using nonparametric methods and a logistic regression model. RESULTS: A total of 166 patients (RACHS 4-6 [49%]), neonates [50%]) were observed. Sixty-one (37%) had at least 1 intraoperative adverse event, and 47 (28.3%) had at least 1 major postoperative adverse event. There was no correlation between intraoperative adverse events and RACHS, preoperative PRISM III, technical performance score, or postoperative adverse events on multivariate analysis. For the entire cohort, better technical performance score resulted in lower postoperative adverse events, lower postoperative PRISM, and lower length of stay and ventilation time (P < .001). Patients requiring intraoperative revisions fared as well as patients without, provided the technical score was at least adequate. CONCLUSIONS: In neonatal and infant open heart repairs, technical performance score is one of the main predictors of postoperative morbidity. Outcomes are not affected by intraoperative adverse events, including surgical revisions, provided technical performance score is at least adequate.
OBJECTIVE: Our objective was to define the relationship between surgical technical performance score, intraoperative adverse events, and major postoperative adverse events in complex pediatric cardiac repairs. METHOD:Infants younger than 6 months were prospectively followed up until discharge from the hospital. Technical performance scores were graded as optimal, adequate, or inadequate based on discharge echocardiograms and need for reintervention after initial surgery. Case complexity was determined by Risk Adjustment in Congenital Heart Surgery (RACHS-1) category, and preoperative illness severity was assessed by Pediatric Risk of Mortality (PRISM) III score. Intraoperative adverse events were prospectively monitored. Outcomes were analyzed using nonparametric methods and a logistic regression model. RESULTS: A total of 166 patients (RACHS 4-6 [49%]), neonates [50%]) were observed. Sixty-one (37%) had at least 1 intraoperative adverse event, and 47 (28.3%) had at least 1 major postoperative adverse event. There was no correlation between intraoperative adverse events and RACHS, preoperative PRISM III, technical performance score, or postoperative adverse events on multivariate analysis. For the entire cohort, better technical performance score resulted in lower postoperative adverse events, lower postoperative PRISM, and lower length of stay and ventilation time (P < .001). Patients requiring intraoperative revisions fared as well as patients without, provided the technical score was at least adequate. CONCLUSIONS: In neonatal and infant open heart repairs, technical performance score is one of the main predictors of postoperative morbidity. Outcomes are not affected by intraoperative adverse events, including surgical revisions, provided technical performance score is at least adequate.
Authors: Anitha Parthiban; Jami C Levine; Meena Nathan; Jennifer A Marshall; Girish S Shirali; Stephen D Simon; Steve D Colan; Jane W Newburger; Geetha Raghuveer Journal: Pediatr Cardiol Date: 2015-09-10 Impact factor: 1.655
Authors: Meena Nathan; Felicia L Trachtenberg; Maria I Van Rompay; William Gaynor; Kirk Kanter; Richard Ohye; Emile A Bacha; James Tweddell; Steven M Schwartz; L LuAnn Minich; Carlos M Mery; Steven D Colan; Jami Levine; Linda M Lambert; Jane W Newburger Journal: J Thorac Cardiovasc Surg Date: 2019-11-15 Impact factor: 5.209
Authors: Meena Nathan; Lynn A Sleeper; Richard G Ohye; Peter C Frommelt; Christopher A Caldarone; James S Tweddell; Minmin Lu; Gail D Pearson; J William Gaynor; Christian Pizarro; Ismee A Williams; Steven D Colan; Carolyn Dunbar-Masterson; Peter J Gruber; Kevin Hill; Jennifer Hirsch-Romano; Jeffrey P Jacobs; Jonathan R Kaltman; S Ram Kumar; David Morales; Scott M Bradley; Kirk Kanter; Jane W Newburger Journal: J Thorac Cardiovasc Surg Date: 2014-06-19 Impact factor: 5.209
Authors: Meena Nathan; Jami C Levine; Maria I Van Rompay; Linda M Lambert; Felicia L Trachtenberg; Steven D Colan; Iki Adachi; Brett R Anderson; Emile A Bacha; Aaron Eckhauser; J William Gaynor; Eric M Graham; Benjamin Goot; Jeffrey P Jacobs; Rija John; Jonathan R Kaltman; Kirk R Kanter; Carlos M Mery; L LuAnn Minich; Richard Ohye; David Overman; Christian Pizarro; Geetha Raghuveer; Marcus S Schamberger; Steven M Schwartz; Shanthi L Narasimhan; Michael D Taylor; Ke Wang; Jane W Newburger Journal: J Am Coll Cardiol Date: 2021-05-18 Impact factor: 24.094
Authors: Hannah R Bellsham-Revell; Antigoni Deri; Silvia Caroli; Andrew Durward; Owen I Miller; Sujeev Mathur; Jelena Saundankar; David R Anderson; B Conal Austin; Caner Salih; Kuberan Pushparajah; John M Simpson Journal: Echo Res Pract Date: 2019-07-09