The Impact of Post-Graduate Year of Primary Surgeon on Technical Performance Score in Tetralogy of Fallot Repair

Shimada, Masatoshi; Hoashi, Takaya; Iida, Jun; Ichikawa, Hajime

doi:10.1253/circj.cj-19-0800

Cited by 2 publications

(10 citation statements)

References 21 publications

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“…Since 2007, researchers at the Boston Children's Hospital have been demonstrating that TPS is an important predictor of short and medium-term outcomes [ 6 , 9 - 13 , 22 , 28 ] . Researchers from England and Japan also evaluated their surgical performance and postoperative outcomes using TPS with similar findings [ 29 , 30 ] .…”

Section: Discussionmentioning

confidence: 92%

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

Miana¹,

Nathan²,

Tenório³

et al. 2021

Braz J Cardiovasc Surg

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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.

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Section: Discussionmentioning

confidence: 92%

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

Miana¹,

Nathan²,

Tenório³

et al. 2021

Braz J Cardiovasc Surg

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“…Of these 434,535 underwent coronary artery bypass grafting (CABG), [10][11][12][13][14][15][16][17][18][19][20] 3090 aortic valve replacements, [21][22][23][24][25] 1740 mitral valve repair/replacement, [24][25][26] 26,433 mixed cardiac surgical cases, 22,24,[27][28][29] 3565 congenital cardiac surgery, 30,31 and 4797 thoracic surgery cases. [32][33][34][35][36][37][38] Total of 398,058 cases were performed by TS and 75,943 by FTS (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…28,29 Even complex congenital cardiac surgery cases can be safely taught in highly specialized teams where the combined experience of the primary surgeon and first assistant have been shown to be an independent predictor of favorable outcome. 30,31 Learning how to perform complex tasks is skill fully accomplished by mastering the smaller components and then combining the skills into an entire operation. Data from academic training programs such as Mass General Hospital 22,23 demonstrate the importance of a stepwise training approach leading to surgeons performing "skin-to-skin" operations where all the operative steps are fully integrated.…”

Section: Discussionmentioning

confidence: 99%

“…The only variable associated with outcomes was the total performance score for the primary and assistant surgeon combined (odds ratio [OR]: 1.07; 95% confidence interval [CI]: 1.01-1.13, p = 0.031). 31 The second study assessed outcomes in 3406 cases where FTS performed 2269 versus TS 1137 cases. 30 Multivariable logistic regression model adjusted for age, sex, weight, lack of preoperative comorbidity, presence of preoperative respiratory failure, The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery category, and need for deep hypothermic circulatory arrest, showed a higher odd of survival in the TS group (OR: 1.484; 95% CI: 0.998−2.206; p = 0.05).…”

Section: Congenital Cardiac Surgerymentioning

confidence: 99%

“…The primary surgeon and first assistant mean postgraduate years were 19.1 ± 5.1 years (range, 5.7−31.6 years) versus 11.2 ± 6.3 years (range, 3.2−36.3 years), respectively. 31 The authors used a technical performance score to assess outcomes in the cases. The only variable associated with outcomes was the total performance score for the primary and assistant surgeon combined (odds ratio [OR]: 1.07; 95% confidence interval [CI]: 1.01-1.13, p = 0.031).…”

Section: Congenital Cardiac Surgerymentioning

confidence: 99%

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Are there differences in cardiothoracic surgery performed by trainees versus fully trained surgeons?

Comanici

Salmasi

Schulte

et al. 2022

Journal of Cardiac Surgery

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Objectives We sought to assess the safety of training in cardiothoracic surgery comparing outcomes of cases performed by trainees versus fully trained surgeons. Methods EmBase, Scopus, PubMed, and OVID MEDLINE were searched in August 2021 independently by two authors. A third author arbitrated decisions to resolve disagreements. Inclusion criteria were articles on cardiothoracic surgery reporting on outcomes for trainees. Studies were assessed for appropriateness as per CBEM criteria. Eight hundred and ninety‐two results were obtained, 27 represented best evidence (2‐meta‐analyses, 1‐RCT, and 24 retrospective cohort studies). Results In all 474,160 operative outcomes were assessed for 434,535 coronary artery bypass grafting (CABG) (431,329 on‐pump vs. 3206 off‐pump), 3090 AVR, 1740 MVR/repair, 26,433 mixed, 3565 congenital, and 4797 thoracic procedures. In all 398,058 cases were performed by trainees and 75,943 by consultants. One hundred fifty‐nine cases were indeterminate. There were no statistically significant differences in the patients' preoperative risk scores. All studies excluded extreme high‐risk patients in emergency setting, patients with poor left ventricular function, and reoperation cases that were undertaken by consultants. There were no differences in cardiopulmonary bypass and clamp times for CABG. Times for valve replacement and repair cases were longer for trainees. There were no differences in the postoperative outcomes including perioperative myocardial infarction, resternotomy for bleeding, stroke, renal failure, intensive therapy unit length of stay, and total length of stay. One study reported no differences on angiographic graft patency at 1 year. There were no differences in in‐hospital or midterm mortality out to 5‐years. Discussion Trainees can perform cardiothoracic surgery in dedicated high‐volume units with outcomes comparable to those of fully trained surgeons.

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The Impact of Post-Graduate Year of Primary Surgeon on Technical Performance Score in Tetralogy of Fallot Repair

Cited by 2 publications

References 21 publications

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

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

Are there differences in cardiothoracic surgery performed by trainees versus fully trained surgeons?

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