Textbook outcome for the Norwood operation—an informative quality metric in congenital heart surgery

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. Th...

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Bibliographic Details
Published in:JTCVS open 2023-09, Vol.15, p.394-405
Main Authors: Prabhu, Neel K., Nellis, Joseph R., Moya-Mendez, Mary, Hoover, Anna, Medina, Cathlyn, Meza, James M., Allareddy, Veerajalandhar, Andersen, Nicholas D., Turek, Joseph W.
Format: Article
Language:English
Subjects:
composite quality measure
Congenital: Norwood
Norwood operation
quality metrics
quality of care
textbook outcome
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Summary: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. 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. 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 
ISSN:2666-2736
2666-2736
DOI:10.1016/j.xjon.2023.05.003