Key result
Technical Performance Score (TPS) class 3 was a significant predictor of higher inhospital mortality (OR 3.2; 95% CI 1.4-7; P=0.004) and complications following congenital heart surgery.
Why the study?
The Technical Performance Score (TPS) developed at Boston Children's Hospital required translation and validation for application in a developing country setting.
Does the translated Boston Technical Performance Score predict clinical outcomes in pediatric congenital heart surgery patients in a developing country?
Cohort (n=972)
No
Does the translated Boston Technical Performance Score predict clinical outcomes in pediatric congenital heart surgery patients in a developing country?
Odds Ratio: 3.2 (95% CI 1.4–7)
p-value: p=0.004
The Portuguese translation of the Boston Technical Performance Score is a valid tool for predicting mortality, complications, and hospital stay in congenital heart surgery in resource-diverse settings.
TPS class 3 may aid postoperative risk stratification in congenital heart surgery; extends TPS validation to developing countries but remains hypothesis-generating.
ValidationWe included consecutive surgeries performed at a single institution between June 2018 and October 2020.Institutional approval with waiver of consent was obtained for this quality improvement initiative under the registration number 95807418.1.0000.0068.We collected demographic data and calculated the complexity risk score using the Risk Adjustment in Congenital Heart Surgery (RACHS-1) mortality categories [20,21] .Cardiopulmonary bypass (CPB) and aortic cross-clamping times, serum lactate levels at the end of surgery, vasoactive inotropic 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.Inhospital 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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Miana et al. (2021) conducted a cohort in Congenital heart surgery (n=972). Technical Performance Score (TPS) class 3 vs. Lower TPS classes was evaluated on Inhospital mortality (OR 3.2, 95% CI 1.4-7, p=0.004). Technical Performance Score (TPS) class 3 was a significant predictor of higher inhospital mortality (OR 3.2; 95% CI 1.4-7; P=0.004) and complications following congenital heart surgery.
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