1. Textbook outcome for the Norwood operation—an informative quality metric in congenital heart surgeryCentral MessagePerspective
- Author
-
Neel K. Prabhu, MD, Joseph R. Nellis, MD, MBA, Mary Moya-Mendez, MS, Anna Hoover, BS, Cathlyn Medina, BS, James M. Meza, MD, MSc, Veerajalandhar Allareddy, MBBS, MBA, Nicholas D. Andersen, MD, and Joseph W. Turek, MD, PhD, MBA
- Subjects
quality of care ,composite quality measure ,quality metrics ,Norwood operation ,textbook outcome ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Surgery ,RD1-811 - Abstract
Objectives: To develop a more holistic measure of center performance than operative mortality, we created a composite “textbook outcome” for the Norwood operation using several postoperative end points. We hypothesized that achieving the textbook outcome would have a positive prognostic and financial impact. Methods: This was a single-center retrospective study of primary Norwood operations from 2005 to 2021. Through interdisciplinary clinician consensus, textbook outcome was defined as freedom from operative mortality, open or catheter-based reintervention, 30-day readmission, extracorporeal membrane oxygenation, cardiac arrest, reintubation, length of stay >75%ile from Society of Thoracic Surgeons data report (66 days), and mechanical ventilation duration >75%ile (10 days). Multivariable logistic regression and Cox proportional hazards modeling were used to determine predictive factors for textbook outcome achievement and association of the outcome with long-term survival, respectively. Results: Overall, 30% (58/196) of patients met the textbook outcome. Common reasons for failure to attain textbook outcome were prolonged ventilation (68/138, 49%) and reintubation (63/138, 46%). In multivariable analysis, greater weight (odds ratio [OR], 2.11; 95% confidence interval [CI], 1.17-3.95; P = .02) was associated with achieving the textbook outcome whereas preoperative shock (OR, 0.36; 95% CI, 0.13-0.87; P = .03) and longer bypass time (OR, 0.99; 95% CI, 0.98-1.00; P = .002) were negatively associated. Patients who met the outcome incurred fewer hospital costs ($152,430 [141,798-177,983] vs $269,070 [212,451-372,693], P
- Published
- 2023
- Full Text
- View/download PDF