title: Intraoperative adverse events can be compensated by technical performance in neonates and infants after cardiac surgery: a prospective study.
abstract: 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.
  
  
  METHODS
  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.affiliation: Department of Cardiac Surgery, Children's Hospital Boston and Harvard Medical School, Boston, Mass, USA.
authors.forename: Meena
authors.initials: M
authors.lastname: Nathan
authors.forename: John M
authors.initials: JM
authors.lastname: Karamichalis
authors.forename: Hua
authors.initials: H
authors.lastname: Liu
authors.forename: Pedro
authors.initials: P
authors.lastname: del Nido
authors.forename: Frank
authors.initials: F
authors.lastname: Pigula
authors.forename: Ravi
authors.initials: R
authors.lastname: Thiagarajan
authors.forename: Emile A
authors.initials: EA
authors.lastname: Bacha
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D002983:Clinical Competence; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units; D007430:Intraoperative Care; D007902:Length of Stay; D016015:Logistic Models; D009519:New York City; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D011182:Postoperative Care; D011446:Prospective Studies; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D012121:Respiration, Artificial; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome