Technical Performance Score Predicts Perioperative Outcomes in Complex Congenital Heart Surgery Performed in a Small-to-Medium-Volume Program

  • Entela B. Lushaj
  • Heather L. Bartlett
  • Luke J. Lamers
  • Shannon Arndt
  • Joshua Hermsen
  • J. Carter Ralphe
  • Petros V. AnagnostopoulosEmail author
Original Article


As the quality of surgical outcomes depend on many factors, the development of validated tools to assess the different aspects of complex multidisciplinary teams’ performance is crucial. The Technical Performance Score (TPS) has only been validated to correlate with outcomes in large-volume surgical programs. Here we assess the utility of TPS in correlation to perioperative outcomes for complex congenital heart surgeries (CHS) performed in a small-to-medium-volume program. 673 patients underwent CHS from 4/2012 to 12/2017 at our institution. Of those, 122 were STAT 4 and STAT 5. TPS was determined for each STAT 4 and STAT 5 operation using discharge echocardiogram: 1 = optimal, 2 = adequate, 3 = inadequate. Patient outcomes were compared including mortality, length of stay, ventilation times, and adverse events. 69 patients (57%) were neonates, 32 (26%) were infants, 17 (14%) were children, 4 (3%) were adults. TPS class 1 was assigned to 85 (70%) operations, TPS class 2 was assigned to 25 (20%) operations, and TPS class 3 was assigned to 12 (10%) operations. TPS was associated with re-intubation, ICU length of stay, postoperative length of stay, and mortality. TPS did not correlate with unplanned 30-day readmissions, need for reoperation, and inotropic score. Technical performance score was associated with perioperative outcomes and is a useful tool to assess the adequacy of repair for high complexity CHS in a small-to-medium-volume surgical program. TPS should be a part of program review in congenital heart programs of all sizes to identify strategies that may reduce postoperative morbidity and potentially improve long-term outcomes.


Small-to-medium-volume program Outcomes Performance score 



This work was funded by the University of Wisconsin, Department of Surgery.

Compliance with Ethical standards

Conflict of interest

None of the authors have a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflict of interest to disclose.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Surgery-Cardiothoracic, School of Medicine and Public HealthUniversity of WisconsinMadisonUSA
  2. 2.Department of Pediatrics-Cardiology, School of Medicine and Public HealthUniversity of WisconsinMadisonUSA
  3. 3.University of Wisconsin Hospital and ClinicsMadisonUSA
  4. 4.Division of Cardiothoracic Surgery, School of Medicine and Public HealthUniversity of WisconsinMadisonUSA

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