Novel Assessments of Technical and Non-Technical Cardiac Surgery Quality

项目摘要/摘要 在每年接受冠状动脉搭桥术的15万名患者中，35%的人 并发症使死亡率增加5倍，费用增加50%。患者风险和手术方式的差异 入路只解释了2%的医院变异的某些并发症。术中阶段仍然存在 作为变异来源的研究不足，尽管其复杂性和改进的顺应性。 不幸的是，人们对影响最佳心脏手术结果的诸多因素知之甚少。在 非心脏手术，同行评分者对外科医生的技术技能(例如，器械操作)的评估是 与并发症相关。除了技术技能，心脏外科团队还独特地依赖于 协调的非技术实践(例如，团队合作、沟通、情景意识、领导力)以 提供护理，包括确保患者在相变期间的血流动力学稳定性，包括 体外循环。到目前为止，大多数研究都集中在技术技能和非 在有主观人类评分者的模拟环境中的技术实践，因此缺乏医疗和 现实世界手术的心理保真度需要确定相关的改进目标。高维 基于计算机的视频记录评估，包括识别和跟踪人的能力 活动(视频理解)可以提供无与伦比的能力，提供客观的、非模拟的- 用于评估手术结果的技术技能和非技术实践的平台。 我们的长期目标是通过确定和促进采用证据来减少手术并发症- 以外科实践为基础。这项建议的目的是：(I)调查同伴之间的关系 评分者对术中技术技能和具有风险调整并发症的非技术操作的评估 (2)评估自动化计算机评估的可行性，以确定重要的 术中技术技能和非技术实践。这项多中心研究利用了两个成熟的 医生协作提供详细的术中数据，与胸科外科医生学会合并 结果数据。我们有以下目标：(1)调查同行评分者之间的关系 评估外科医生的技术技能和风险调整后患者并发症的可变性；(2)调查 同行评分者对术中基于团队的非技术实践的评估与 风险调整后患者并发症的可变性；(3)探索使用客观的、数据驱动的 基于计算机的评估，以自动识别和跟踪重要的术中 风险调整后患者并发症的决定因素。这项研究与NHLBI的优先事项一致，通过 利用一个多学科团队来确定手术性能的可修改决定因素，预计将 通过使用一个广泛评估手术结果的平台来积极影响护理。

Project Summary/Abstract Of the 150,000 patients annually undergoing coronary artery bypass grafting surgery, 35% develop complications that increase mortality 5-fold and expenditures by 50%. Differences in patient risk and operative approach explain only 2% of hospital variation in some complications. The intraoperative phase remains understudied as a source of variation, despite its complexity and amenability to improvement. Unfortunately, little is known about the multitude of factors impacting optimal cardiac surgical outcomes. Within non-cardiac surgery, peer rater assessments of a surgeon’s technical skills (e.g., instrument handling) are correlated with complications. Beyond technical skills, the cardiac surgical team uniquely relies on carefully orchestrated non-technical practices (e.g., teamwork, communication, situational awareness, leadership) to deliver care, including ensuring the patient’s hemodynamic stability across phase transitions involving extracorporeal cardiopulmonary bypass. Most research to date has focused on technical skills and non- technical practices in simulated environments with subjective human raters, thus lacking the medical and psychological fidelity of real-world surgery required to identify relevant improvement targets. High-dimensional computer-based assessments of video recordings, including capabilities for recognizing and tracking human activity (video understanding), may offer unparalleled capabilities for providing an objective, non-simulation- based platform for assessing technical skills and non-technical practices of surgical outcomes. Our long-term goal is to reduce surgical complications by identifying and promoting adoption of evidence- based surgical practices. The objectives of this proposal are to: (i) investigate the relationship between peer rater assessments of intraoperative technical skills and non-technical practices with risk-adjusted complication rates and (ii) to evaluate the feasibility of automating computer-based assessments to identify important intraoperative technical skills and non-technical practices. This multi-center study leverages two mature physician collaboratives providing detailed intraoperative data merged with The Society of Thoracic Surgeons outcomes data. We have the following aims: (1) To investigate the relationship between peer rater assessments of surgeon technical skills and variability in risk-adjusted patient complications; (2) To investigate the relationship between peer rater assessments of intraoperative team-based non-technical practices and variability in risk-adjusted patient complications; (3) To explore the feasibility of using objective, data-driven computer-based assessments to automate the identification and tracking of significant, intraoperative determinants of risk-adjusted patient complications. This study, which aligns with NHLBI’s priorities by leveraging a multidisciplinary team to identify modifiable determinants of surgical performance, is expected to positively impact care by using a platform to broadly evaluate surgical outcomes.