title: Inadequate technical performance scores are associated with late mortality and late reintervention.
abstract: 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.
authors.affiliation: Department of Cardiac Surgery, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02215, USA. meena.nathan@cardio.chboston.org
authors.forename: Meena
authors.initials: M
authors.lastname: Nathan
authors.forename: Frank A
authors.initials: FA
authors.lastname: Pigula
authors.forename: Hua
authors.initials: H
authors.lastname: Liu
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.forename: Steven D
authors.initials: SD
authors.lastname: Colan
authors.forename: Francis
authors.initials: F
authors.lastname: Fynn-Thompson
authors.forename: Sitaram
authors.initials: S
authors.lastname: Emani
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Baird
authors.forename: John E
authors.initials: JE
authors.lastname: Mayer
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: Del Nido
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality* / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
keywords: 18