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Intraoperative adverse events can be compensated by technical performance in neonates and infants after cardiac
Meena Nathan1, John M Karamichalis, Hua Liu
1Department of Cardiac Surgery, Children's Hospital Boston and Harvard Medical School, Boston, Mass, USA.
Insights
In pediatric cardiac surgery, a higher technical performance score is linked to fewer postoperative complications. Intraoperative issues, including revisions, do not impact outcomes if technical skill remains adequate.
Area of Science:
- Pediatric Cardiac Surgery
- Surgical Performance Metrics
- Patient Outcomes
Background:
- Complex pediatric cardiac repairs carry inherent risks.
- Understanding factors influencing adverse events is crucial for improving outcomes.
Purpose of the Study:
- To define the relationship between surgical technical performance, intraoperative adverse events, and major postoperative adverse events in complex pediatric cardiac repairs.
- To identify key predictors of morbidity in neonatal and infant open-heart surgeries.
Main Methods:
- Prospective follow-up of infants under 6 months undergoing complex cardiac repair.
- Technical performance scoring based on echocardiograms and reintervention needs.
- Analysis of intraoperative adverse events, case complexity (RACHS-1), and preoperative severity (PRISM III).
Main Results:
- A total of 166 infants were studied; 37% experienced intraoperative adverse events, and 28.3% had major postoperative adverse events.
- No correlation found between intraoperative adverse events and RACHS, PRISM III, technical score, or postoperative events.
- Better technical performance scores significantly correlated with lower postoperative adverse events, improved PRISM scores, and reduced length of stay/ventilation time (P < .001).
Conclusions:
- Technical performance score is a primary predictor of postoperative morbidity in neonatal and infant open-heart repairs.
- Intraoperative adverse events and surgical revisions do not negatively affect outcomes when technical performance is 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.
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