Intraoperative adverse events can be compensated by technical performance in neonates and infants after cardiac surgery: A prospective study Meena Nathan,

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Presentation transcript:

Intraoperative adverse events can be compensated by technical performance in neonates and infants after cardiac surgery: A prospective study Meena Nathan, MD, John M. Karamichalis, MD, Hua Liu, MS, Pedro del Nido, MD, Frank Pigula, MD, Ravi Thiagarajan, MD, MPH, Emile A. Bacha, MD The Journal of Thoracic and Cardiovascular Surgery Volume 142, Issue 5, Pages 1098-1107.e5 (November 2011) DOI: 10.1016/j.jtcvs.2011.07.003 Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 ROC curve analysis of ability of technical performance, RACHS-1 categories, and preoperative PRISM to predict major postoperative adverse events. On logistic regression, technical performance had a higher (albeit small difference) significance in predicting occurrence of postoperative adverse events with an area under the curve of 0.774 (95% CI, 0.681-0.867) versus 0.756 (95% CI, 0.681-0.832) for RACHS-1 category versus 0.732 (95% CI, 0.650-0.814). ROC, Receiver operator characteristic; RACHS, Risk Adjustment in Congenital Heart Surgery; PRISM, Pediatric Risk of Mortality; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1098-1107.e5DOI: (10.1016/j.jtcvs.2011.07.003) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Major postoperative adverse events based on technical scores and RACHS-1 categories. This figure outlines the percentage of patients with major postoperative adverse events comparing technical performance and RACHS-1 risk categories. Optimal technical performance had a low occurrence of adverse events, whereas adequate technical performance had low rates of adverse events in the low complexity groups (RACHS-1 categories 2 and 3, but higher percentage of adverse events in the higher risk categories (RACHS-1 categories 4 and 6). Inadequate technical performance had the highest percentage with adverse events in all categories of the RACHS-1 system. RACHS, Risk Adjustment in Congenital Heart Surgery. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1098-1107.e5DOI: (10.1016/j.jtcvs.2011.07.003) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Postoperative ICU LOS for intraoperative surgical reinterventions versus postoperative surgical reinterventions or catheter-based reinterventions when compared with those who had no intervention: The was no statistical difference in the median LOS for patients who had no reinterventions (6 days) versus patients with intraoperative reinterventions (13 days) (P = .141). However, patients who had postoperative surgical or catheter-based reinterventions had a significantly longer LOS (32 days) (P = .005 vs intraoperative reinterventions, P < .0001 vs no reinterventions). ∗Outliers. ICU, Intensive care unit; LOS, length of stay. The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1098-1107.e5DOI: (10.1016/j.jtcvs.2011.07.003) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Comparison of occurrence of major adverse events for no intervention versus intraoperative intervention versus postoperative surgical or catheter-based interventions. There was significantly higher incidence of major postoperative adverse events in the postoperative surgical/catheter reinterventions group (P < .0001 vs no intervention, P = .007 intraoperative surgical reinterventions). The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1098-1107.e5DOI: (10.1016/j.jtcvs.2011.07.003) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Comparison of mortality for no intervention versus intraoperative intervention versus postoperative surgical or catheter-based interventions. There is a significantly higher mortality for patients who underwent postoperative surgical/catheter reinterventions when compared with those who had no reintervention (P < .0001). The Journal of Thoracic and Cardiovascular Surgery 2011 142, 1098-1107.e5DOI: (10.1016/j.jtcvs.2011.07.003) Copyright © 2011 The American Association for Thoracic Surgery Terms and Conditions