Abstract
IntroductionThe 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.MethodsThe 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.ResultsMedian age and weight were 2.2 (interquartile range [IQR] = 0.5-13) years and 10.8 (IQR = 5.6-40) kilograms, respectively. In-hospital 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).ConclusionTPS 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.
Highlights
The Technical Performance Score (TPS) was developed and subsequently refined at the Boston Children’s Hospital
Congenital heart disease (CHD) remains a major healthcare issue, and mitigating CHD mortality in developing countries could have a significant impact on the elevated childhood mortality rates[1,2,3]
What is the real impact of these echocardiographic findings on the patient’s outcomes? The Boston Children’s Hospital developed a quality assessment tool, the Technical Performance Score (TPS)[9,10,11,12,13], that quantified the degree of residual lesions based on echocardiographic and clinical findings
Summary
The Technical Performance Score (TPS) was developed and subsequently refined at the Boston Children’s Hospital. Congenital heart disease (CHD) remains a major healthcare issue, and mitigating CHD mortality in developing countries could have a significant impact on the elevated childhood mortality rates[1,2,3]. Several factors affect the final outcome of CHD repair, and predictors of unfavorable events can often be identified before surgery[4,5,6]. What is the real impact of these echocardiographic findings on the patient’s outcomes? The Boston Children’s Hospital developed a quality assessment tool, the Technical Performance Score (TPS)[9,10,11,12,13], that quantified the degree of residual lesions based on echocardiographic and clinical findings What is the real impact of these echocardiographic findings on the patient’s outcomes? The Boston Children’s Hospital developed a quality assessment tool, the Technical Performance Score (TPS)[9,10,11,12,13], that quantified the degree of residual lesions based on echocardiographic and clinical findings
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