Translation and Validation of the Boston Technical Performance Score in a Developing Country

Abstract

Introduction The Technical Performance Score (TPS) was developed and subsequently refined at the Boston Children's Hospital. Our objective was to translate and validate its application in a developing country. Methods The score was translated into the Portuguese language and approved by the TPS authors. Subsequently, we studied 1,030 surgeries from June 2018 to October 2020. TPS could not be assigned in 58 surgeries, and these were excluded. Surgical risk score was evaluated using Risk Adjustment in Congenital Heart Surgery (or RACHS-1). The impact of TPS on outcomes was studied using multivariable linear and logistic regression adjusting for important perioperative covariates. Results Median age and weight were 2.2 (interquartile range [IQR] = 0.5-13) years and 10.8 (IQR = 5.6-40) kilograms, respectively. In-hospital mortality was 6.58% (n=64), and postoperative complications occurred in 19.7% (n=192) of the cases. TPS was categorized as 1 in 359 cases (37%), 2 in 464 (47.7%), and 3 in 149 (15.3%). Multivariable analysis identified TPS class 3 as a predictor of longer hospital stay (coefficient: 6.6; standard error: 2.2; P =0.003), higher number of complications (odds ratio [OR]: 1.84; 95% confidence interval [CI]: 1.1-3; P =0.01), and higher mortality (OR: 3.2; 95% CI: 1.4-7; P =0.004). Conclusion TPS translated into the Portuguese language was validated and showed to be able to predict higher mortality, complication rate, and prolonged postoperative hospital stay in a high-volume Latin-American congenital heart surgery program. TPS is generalizable and can be used as an outcome assessment tool in resource diverse settings.

A New Dawn for Brazilian Pediatric Cardiac Surgery Is on the Way — Issues Around and Outside the Operating Room

“…Although it has not yet reached all Brazilian centers, this database was critical in evaluating costs in PCS in our country, helping to update the reimbursement tables for hospitals in the health system. More recently, another significant contribution published in Brazilian scientific journals, with international experts’ collaboration, deserves to be highlighted: the Translation and Validation of the Boston Technical Performance Score (TPS) in a Developing Country [ 39 ] . The authors showed their initial experience using TPS translated to Portuguese for their congenital cardiac surgical team’s performance analysis.…”

The Keys to Unleashing Potential

“…In the past issue of Brazilian Journal of Cardiovascular Surgery, Miana LA et al [ 1 ] have transparently demonstrated technical performance scores (TPS Classes 1 to 3) for 972 congenital cardiac surgical cases. A TPS Class 3 (inadequate) was independently associated with higher mortality and morbidity.…”