Abstract
The frequency and impact of medical errors during staged palliation are unknown. All patients with hypoplastic left heart syndrome and physiologic equivalents (N=191) who underwent staged palliation (2001-2011) were studied. Stage 1, interstage, and stage 2 were reviewed to identify diagnostic, technical, judgment, and management errors. The impact of errors on transplant-free survival was examined by parametric competing risks and risk-adjusted regressions using bootstrapping. Stage 1 (N=191) errors (n=111, 58%) were common and predominantly intraoperative (n=84, 44%) or postoperative (n=43, 23%). Postoperative errors were determinants of death/transplant (hazard ratio, 1.7; P=.01), whereas technical errors (n=65, 34%) were not, but they delayed recovery and discharge (extra 24 days approximately, P=.0024). Postoperative stage 1 errors led to decrements in total strategy success of approximately 30% (78% vs 48%, P=.004). Stage 2 (N=134) errors (n=66, 49%) were common. Intraoperative errors were the most prevalent (n=61, 46%) but did not compromise survival. Postoperative errors (n=11, 8%) were determinants of death/transplant (hazard ratio, 2.4; P<.0001). Interstage errors (n=21, 16%) led to twice the intensive care unit stay (16 vs 7 days, P<.0001) and hospital stay (30 vs 17 days, P<.02) after stage 2. Overall, a child presenting with ideal morphology and managed with no postoperative errors at stage 1 or 2 would have a predicted late survival in excess of 80%. Technical errors are common and delay recovery. Their effects on survival are mitigated. Intraoperative judgment errors are associated with strategy failure in a univariate model and lead to increased postoperative errors in a multivariate model. Postoperative errors are independently associated with a decrease in univentricular strategy survival.
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More From: The Journal of Thoracic and Cardiovascular Surgery
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