A Study On The Surgical Quality Evaluation Index Of Complete Atrioventricular Septal Defect

Objective To investigate the possibility and advantages of establishing a surgical quality evaluation index for complete atrioventricular septal defect(cAVSD)based on clinical data and expert experience under an evidence-based medical research paradigm.Methods Patients with cAVSD who received primary correction from November 1,2009,to July 15,2020,in a single-center are retrospectively included.Patients who received nonbiventricular correction are excluded,and clinical characteristics related to in-hospital adverse events after cAVSD surgery are analyzed by univariate and multivariate logistic regression.Patients with non-biventricular correction and combined TOF,TGA,and PA are excluded,and the prognosis of correction at age less than 6 months,less than 3 months,and at a weight less than 4.5 kg are analyzed by the Kaplan-Meier method,and differences of correction between operators are analyzed.Same as previous inclusion and exclusion criteria,patients with the depth of ventricular septal defect less than 10 mm are excluded,and the differences between cAVSD patients with large ventricular septal defect receiving the modified-single patch and double-patch method are analyzed.Results Finally 211 patients with cAVSD are included in the analysis.Analysis of risk factors associated with in-hospital adverse events suggests that patients younger than 3 months(OR = 3.456,95% CI: 1.154 to 11.969,P = 0.035)and length of ICU stay >3 days(OR = 1.676,95% CI: 0.918 to 3.076,P = 0.093)have a strong correlation of the at least one postoperative in-hospital adverse event.Concomitant cardiac anomalies(OR = 0.177,95% CI: 0.048 to 0.681,P = 0.009)and more than moderate left atrioventricular valve regurgitation(OR = 4.43,95%CI: 1.054 to 30.148,P = 0.067)are independent risk factors for patient death.208 patients are included in age,weight,and operator analysis.Age analysis suggests that despite a significantly higher rate of postoperative complications(P = 0.001)and a near borderline statistical significant of postoperative reintervention events(P = 0.064)in younger than 3 months of age,while age of cAVSD patients younger than 3 months and younger than 6 months have no statistical differences in overall survival,reintervention-free survival,and LAVVR-free survival compared with older age patients.Weight analysis suggests that surgical correction of low weight cAVSD less than 4.5 kg is safe,but patients with low weight have higher rates of postoperative complication events(P = 0.039),LAVVR(P = 0.0031),and reintervention events(P = 0.03)after surgery.The operator analysis suggests no significant differences in overall cAVSD survival and prognostic endpoint events between different operators.Analysis of the large ventricular defect type cAVSD suggests that the modified single-patch method has a shorter cardiopulmonary bypass time and aortic block time than the two-patch method,but the modified single-patch correction group has a longer total postoperative hospital stay(29 vs 18.5days,P = 0.01).There was no significant difference between the two groups in terms of longterm overall survival,event-free survival,and LAVVR-free survival.Conclusion In-depth studies of indexes related to adverse events will help us to improve the quality of in-hospital care through early intervention of risk factors,as well as to reduce mortality in high-risk patients through regular follow-up.The study on the index of weight and age at correction suggests that the proportion of correction less than 3 months of age and less than 4.5 kg as the index of cAVSD surgical quality evaluation can help to further improve the level of accurate diagnosis and treatment of the disease while ensuring the surgical technique.And the index of the proportion of correction by the two-piece method in patients with large ventricular defect type cAVSD might be able to reduce the total length of patients’ stay in hospital and improve the quality of patients’ survival.There is no difference between different operators also gives the possibility of assessing all operators with the same set of surgical quality evaluation indexes for cAVSD.And the evaluation indexes can be further validated and supported by prospective experiments,and in general,the establishment of cAVSD surgical quality evaluation indexes based on clinical data and expert experience is possible.