Novel Assessments of Technical and Non-Technical Cardiac Surgery Quality

项目总结/摘要 在每年接受冠状动脉旁路移植术的15万例患者中， 并发症使死亡率增加5倍，费用增加50%。患者风险和手术风险的差异 这种方法只能解释某些并发症中2%的医院差异。术中阶段仍然是 作为变异的来源，尽管它的复杂性和可改进性，但研究不足。 不幸的是，人们对影响最佳心脏手术结局的众多因素知之甚少。内 非心脏手术，外科医生技术技能的同行评估者评估（例如，仪器操作）是 与并发症有关。除了技术技能，心脏外科团队还特别依赖于 协调的非技术实践（例如，团队合作、沟通、态势感知、领导力）， 提供护理，包括确保患者的血流动力学稳定性跨越相变， 体外循环迄今为止，大多数研究都集中在技术技能和非技术技能上。 技术实践中的模拟环境与主观的人类评分，从而缺乏医疗和 确定相关改善目标所需的真实手术的心理逼真度。高维 基于计算机的视频记录评估，包括识别和跟踪人类的能力 活动（视频理解），可以提供无与伦比的能力，提供一个客观的，非模拟- 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识别和促进采用证据来减少手术并发症- 基于外科实践。这项建议的目的是：（一）调查同侪之间的关系 术中技术技能和非技术实践的评定者评估（风险调整后的并发症） （ii）评估以计算机为基础的评估自动化的可行性，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 医生合作提供与胸外科医师协会合并的详细术中数据 成果数据。本研究的主要目的是：（1）研究同伴评分者与被试的关系 评估外科医生的技术技能和风险调整后的患者并发症的变异性;（2）调查 同行评估者对基于术中团队的非技术实践的评估之间的关系， 风险调整后的患者并发症的变异性;（3）探索使用客观，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 风险调整患者并发症的决定因素。这项研究符合NHLBI的优先事项， 利用多学科团队来确定手术性能的可修改决定因素，预计将 通过使用平台广泛评估手术结果，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.