Appraisal of the selectivity index in a cohort of patients treated with laser surgery for twin-twin transfusion syndrome

Luminita S. Crisan, Eftichia V. Kontopoulos, Rubén A. Quintero

Research output: Contribution to journalArticle

5 Scopus citations

Abstract

Objective: The selectivity index (SI) has been proposed as a measure of technical success in laser surgery for twin-twin transfusion syndrome. Surgeries with an index >-0.25 have been considered highly selective. The purpose of this study was to evaluate the applicability of this index in our patient population. Study Design: The SI was assessed in 314 consecutive laser surgeries and correlated with perinatal survival. Results: A total of 310 patients (98.7%) underwent a completely selective procedure. The SI was 0.8 in the selective laser photocoagulation of communicating vessels group vs 0.3 in the nonselective laser photocoagulation of communicating vessels group (P = .001). In the selective group perinatal survival of at least 1 twin (92.6% vs 50%) and survival of the donor (75.4% vs 0%) was significantly better (P = .05). Conclusion: The SI as originally proposed is misleading and of limited use as it does not differentiate selective from nonselective procedures. We propose instead using a ratio of selective/nonselective procedures, and selectively coagulated/total number of coagulated vessels to appraise center-specific and patient-specific surgical performance of laser surgery for twin-twin transfusion syndrome.

Original languageEnglish (US)
Pages (from-to)157.e1-157.e5
JournalAmerican journal of obstetrics and gynecology
Volume202
Issue number2
DOIs
StatePublished - Feb 2010

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Keywords

  • laser photocoagulation
  • selectivity
  • twin-twin transfusion syndrome

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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