General thoracic and adult cardiac (“cardiothoracic”) surgical procedures are among the most frequently performed high-risk inpatient procedures. Despite technological advances and quality improvement initiatives (e.g., outcomes reporting), major complications remain common (10-34%), vary by hospital (4%-35%), increase the risk of mortality (atrial fibrillation: 3%; cardiac arrest: 49%) and add $6K-$34K to expenditures. Emerging data linking surgeon operative performance, encompassing technical and non-technical (e.g., communication, decision-making) skills, with patient outcomes after non-cardiac surgery reveals that surgical technical skills are necessary yet alone are insufficient for achieving high performance. Researchers have evaluated both faculty and trainee (i.e., interns, residents and fellows) cardiothoracic surgeon operative performance with validated taxonomies; yet, this work has: (1) often been conducted within simulated scenarios lacking medical and psychological challenges of real-world surgery and (2) lacked structure to improve and monitor performance over one’s career. Relevant to these observations are developments within the discipline of sport (e.g., professional tennis) that have pioneered advanced performance parameters for athletes. The U.S. Tennis Association (USTA), for instance, develops data-driven analytics applied to annotated in-game video to analyze technical, tactical and physical ability and emotional regulation as important tools to develop athletes, especially during high-intensity situations. The application of USTA’s Player Development approach to surgeons uniquely advances real-world surgeon-specific operative performance parameters given the increased use of digital technology and similarities between athletes and surgeons that extend to the following surgical domains: (1) technical (e.g., economy of motion); (2) tactical (e.g., sequencing of tasks); (3) cognitive (e.g., situation awareness); and (4) physical (e.g., stamina, ergonomics). While biomarkers reflecting a player’s physiology (e.g., heart rate variability) and human factors (e.g., fatigue, task load) are measured within sport, their role in explaining additional variance in surgical outcomes beyond operative performance ratings is understudied. Our long-term goal is to enhance surgical outcomes by identifying and promoting the wide-scale adoption of evidence-based operative performance practices. The objective of this proposal is to obtain validity evidence supporting the development of a surgeon-specific performance index for cardiothoracic surgery. The proposed multi-center study leverages our team’s expertise in applying data analytics to recorded, real operative video, and a unique partnership with USTA’s Player Development program. We have the following aims: (1) Develop a multidomain cardiothoracic surgeon operative performance index; (2) Identify biomarkers associated with a surgeon’s operative performance; and (3) Qualitatively assess d...