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Is cardiac surgery warranted in children with Down syndrome? A case-controlled review
M A Roussot1, J B Lawrenson, J Hewitson
1Division of Critical Care and Children's Heart Diseases, School of Child and Adolescent Health, University of Cape Town and Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa.
Insights
Children with Down syndrome (DS) and those without experienced similar healthcare burdens after congenital heart disease surgery. Denying DS children surgery is not a viable resource allocation strategy.
Area of Science:
- Pediatric Cardiology
- Health Services Research
- Genetics
Background:
- Congenital heart disease (CHD) is a common comorbidity in children with Down syndrome (DS).
- Resource allocation in healthcare is a critical consideration, particularly for specialized surgical interventions.
Purpose of the Study:
- To compare the healthcare system burden of children with and without Down syndrome undergoing congenital heart disease repair.
- To investigate the impact of Down syndrome on outcomes following cardiac surgery.
Main Methods:
- Retrospective case-control study at Red Cross War Memorial Children's Hospital, Cape Town.
- Compared 50 children with Down syndrome to 50 non-syndromic children who underwent cardiac surgery (1998-2003).
- Outcome measures included hospital/ICU stay, complication rates, re-operation, and mortality.
Main Results:
- No significant difference in healthcare system burden between the Down syndrome and control groups.
- Similar complication, re-operation, and early mortality rates were observed in both groups.
- Children with Down syndrome appeared to derive greater benefit from cardiac surgery.
Conclusions:
- Denying cardiac surgery to children with Down syndrome does not improve healthcare resource allocation efficiency.
- Discrimination against children with Down syndrome is not a justifiable approach to managing scarce resources.
- Equitable access to cardiac surgery for children with Down syndrome is supported by these findings.
Objectives:
To compare children with Down syndrome and children without Down syndrome and investigate whether there is a significant difference in the burden that is placed on the health care system between these two groups only in respect of the repair of congenital heart disease at Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
Design:
This study is a retrospective case control review.
Setting:
Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
Subjects:
The sample group of 50 Down syndrome children who had received cardiac surgery between January 1998 and June 2003 was compared with a control group of 50 nonsyndromic children who had received cardiac surgery during the same period.
Outcome Measures:
Sex and diagnoses (cardiac and noncardiac), number of days spent in hospital and in ICU, complication rates, re-operation rates, early mortality rates, planned further cardiac surgery. Costs of these outcomes were not quantified in exact monetary terms.
Results:
There was no significant difference between the two groups in terms of the burden that was placed on the health care system. Similar complication rates, re-operation rates and early mortality rates were recorded for both groups. The Down syndrome group appeared to benefit more from cardiac surgery than the non-Down syndrome group.
Conclusion:
Denying cardiac surgery to children with Down syndrome does not improve the efficiency of resource allocation. It is therefore not reasonable to suggest that the problem of scarce resources can be ameliorated by discriminating against children with Down syndrome.
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