Impact of operator experience and volume on outcomes after complete repair for tetralogy of Fallot

Eur J Cardiothorac Surg. 2021 Jul 14;60(1):105-112. doi: 10.1093/ejcts/ezab060.

Abstract

Objectives: The aim of this study was to assess the impact of individual operator experience on outcomes after complete repair for tetralogy of Fallot.

Methods: This is a retrospective cohort study. Consecutive patients who underwent TOF repair at a single institution were included and compared according to whether the primary operator was an experienced, high-volume operator (defined as an operator who performed at least 20 surgical procedures for congenital heart disease defined as complex by the Risk Adjustment for Congenital Heart Surgery classification per year for at least 3 consecutive years). The primary outcome was defined as a composite of death, or reintervention, or significant annular peak gradient, or significant pulmonary regurgitation. Multivariable logistic regression and Cox proportional-hazards model analyses were used to assess the relationships between operator experience and outcomes.

Results: From January 2012 to December 2017, a total of 1760 patients with primary diagnosis of TOF underwent TOF repair by 37 operators. Of these, 5 operators (13.5%) were considered experienced, and 32 (86.5%) were considered less experienced. Complete follow-up data were available for 1728 complete repair for TOF patients with a median follow-up duration of 49 months; in 611 patients (35.4%), the surgery was performed by experienced operators, and in 1117 patients (64.6%), the surgery was performed by less experienced operators. Adjusted risks for the primary outcome and significant pulmonary regurgitation were lower for patients who were treated by experienced operators, both at discharge [adjusted odds ratio 0.67, 95% confidence interval (CI) 0.50-0.90; adjusted odds ratio 0.54, 95% CI 0.37-0.78, respectively] and at follow-up (adjusted hazard ratio 0.82, 95% CI 0.68-0.97; adjusted hazard ratio 0.70, 95% CI 0.56-0.87, respectively). The trend for the primary outcome during follow-up remained unchanged, even in most subgroups.

Conclusions: Increased surgeon experience is associated with improved risk-adjusted outcomes. These results have potentially important implications for individual training, quality improvement and hospital programmes in the context of complete repair for TOF.

Registration number: http://www.chictr.org.cn number, ChiCTR2000033234.

Keywords: Operator experience; Operator volume; Quality improvement; Tetralogy of Fallot.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Humans
  • Infant
  • Proportional Hazards Models
  • Pulmonary Valve Insufficiency*
  • Retrospective Studies
  • Tetralogy of Fallot* / surgery
  • Treatment Outcome

Associated data

  • ChiCTR/ChiCTR2000033234