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Postoperative Infection in Developing World Congenital Heart Surgery Programs: Data From the International Quality
Amitabh Chanchal Sen1, Debra Forbes Morrow2, Rakhi Balachandran2
1From the Department of Cardiac Anesthesiology (A.C.S., R.B.) and Department of Pediatric Cardiology (R.K.K.), Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India; Department of Cardiology (D.F.M., K.G., J.K.K., K.J.J.) and Infection Prevention and Control (G.P.-B.), Boston Children's Hospital, MA; Department of Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, China (X.D.); Department of Cardiovascular Surgery, Star Hospital, Hyderabad, India (B.R.J.); Department of Family Medicine, Scripps Mercy Hospital Chula Vista, CA (M.L.M.); Department of Intensive Care, Nhi Dong No 1 (Children's Hospital No 1), Ho Chi Minh City, Viet Nam (N.T.C.); and Department of Cardiac Anesthesiology and Critical Care, Instituto Nacional de Pediatria and Kardias/American British Chowdry Hospital Project, Mexico City (O.T.-C.). dramitabhsen@gmail.com.
Postoperative infections after congenital heart surgery increase mortality and complications. Younger age and complex procedures are key risk factors, highlighting the need for targeted infection control in developing nations.
Area of Science:
- Pediatric Cardiac Surgery
- Infectious Diseases
- Global Health
Background:
- Postoperative infections are a significant cause of morbidity and mortality in congenital heart disease (CHD) surgery.
- These infections are often preventable, emphasizing the need for risk factor identification.
- The International Quality Improvement Collaborative (IQIC) provided data from developing countries.
Purpose of the Study:
- To identify risk factors for postoperative infections following CHD surgery.
- To assess the impact of these infections on patient outcomes.
- To analyze data from developing countries to inform quality improvement initiatives.
Main Methods:
- Analysis of pediatric cardiac surgical cases (2010-2012) from 27 sites in 16 developing countries.
- Inclusion of demographics, preoperative, procedural, and outcome data.
- Univariate and multivariable logistic regression to identify infection risk factors and clinical outcomes.
Main Results:
- 5.5% of 14,545 cases had bacterial sepsis; 2.1% had surgical site infection.
- Infection significantly increased in-hospital mortality (16.7% vs. 5.3%), ventilation duration, and ICU stay.
- Younger age, higher surgical complexity, lower oxygen saturation, and major illness were independent risk factors for infection.
Conclusions:
- Postoperative infections significantly increase mortality and morbidity after CHD surgery.
- Younger patients and those undergoing more complex procedures face higher infection risks.
- Targeted quality improvement efforts focused on infection prevention can reduce adverse outcomes in developing regions.