Prediction and Perception of Technical Difficulties in Adult Cardiac Surgery

  • Yasser Y Hegazy Department of Cardiac Surgery, Mediclin Herrzzentrum Lahr/ Baden, Germany.
  • Mohamed Samy Nassar Department of Cardio-thoracic Surgery, Faculty of Medicine, Alexandria University, Egypt
  • Wael Hassanein Department of Cardio-thoracic Surgery, Faculty of Medicine, Alexandria University, Egypt
  • Moustafa Elhamami Department of Cardio-thoracic Surgery, Faculty of Medicine, Alexandria University, Egypt
  • Juergen Ennker School of Medicine, Faculty of Health, University of Witten Herdecke, Witten, Germany

Abstract

Background: Unexpected intra-operative technical difficulties are not uncommon in cardiac surgery. Our objective is to study the incidence, predictors, and consequences of unexpected difficulties in adult cardiac operations. 

Methods: A total of 500 consecutive elective operations were included in the study. Before every operation, the surgeon and the assistant were asked to study the case and give a score (one to ten) for the expected technical difficulty of the operation. After every operation, the surgeon and the assistant were asked to give a score for the observed technical difficulty. The scores and perioperative data were collected and statistically analyzed.

Results: In relation to different interventions and consultant/trainee predictions, unexpected technical difficulties were encountered in 7% to 16% of cases. There was a significant difference between surgeons and trainees in the perception of level of increased difficulty, represented by the mean of differences between expected and observed score (0.084 ± 0.54 versus 0.016 ± 0.5, P = .0002). In multivariable analysis, only female gender (P < .0001) was identified as a factor associated with unexpected technical difficulties. There was no correlation between the incidence of complications and unexpected surgical difficulty. However, there was a weak positive correlation between operative times and observed
difficulty score. 

Conclusion: Unexpected technical difficulties are not uncommon in adult cardiac operations. Trainees tend to underestimate the difficulties perceived by the surgeon. This study can be a first step towards developing a technical difficulty score, which could be a helpful tool for medical quality management, as well as in training programs.

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Published
2018-06-26
Section
Articles