Inadequate technical performance scores are associated with late mortality and late reintervention

Ann Thorac Surg. 2013 Aug;96(2):664-9. doi: 10.1016/j.athoracsur.2013.04.043. Epub 2013 Jun 16.


Background: We have shown previously that technical performance score (TPS) is strongly associated with early mortality and major postoperative adverse events in a diverse group of patients. We now report evaluation of the validity of TPS in predicting late outcomes in the same group of patients.

Methods: Patients who underwent surgery between June 1, 2005 and June 30, 2006 were included. The TPS were assigned based on discharge echocardiograms and certain clinical criteria as previously described. Follow-up data for up to 4 years were retrospectively collected. Cox proportional hazards models were used for analysis.

Results: A total of 679 patients were included in the analysis. One hundred twenty-three (18%) were neonates, 213 (31%) infants, 291 (435) children, and 52 (8%) adults. Four hundred ninety-one (72%) were in low-risk adjustment in congenital heart surgery (RACHS; 1 to 3), 109 (16%) in high risk (4 to 6), and 27 (4%) were less than 18 years and could not be assigned a RACHS score. Three hundred thirty-one (48%) had an optimal TPS, 283 (42%) adequate, 61 (9%) inadequate, and 4 (1%) could not be scored. There were 34 (5%) late deaths and 149 (22%) late unplanned reinterventions. By univariate analysis, age, RACHS-1 categories, and TPS were all significantly associated with late reintervention (p < 0.001 for all), while TPS and RACHS-1 were significant factors for mortality (p < 0.001). On multivariable modeling, inadequate TPS was strongly associated with both late mortality (p = 0.001; HR [hazard ratio] 3.8, CI [confidence interval] 1.7 to 8.4) and late reintervention (p = 0.002, HR 2.1, CI 1.3 to 3.3) after controlling for RACHS-1 and age.

Conclusions: The TPS has a strong association with late outcomes across a wide range of age and disease complexity and may serve as a tool to identify patients who are at a higher risk for late reintervention or mortality.

Keywords: 18.

MeSH terms

  • Adolescent
  • Adult
  • Cardiac Surgical Procedures / adverse effects
  • Cardiac Surgical Procedures / mortality*
  • Cardiac Surgical Procedures / standards*
  • Child
  • Child, Preschool
  • Clinical Competence*
  • Humans
  • Infant
  • Infant, Newborn
  • Reoperation / statistics & numerical data
  • Retrospective Studies
  • Time Factors
  • Young Adult