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Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
Perioperative complications in a paediatric cardiac surgery program with limited systemic resources
Igor V Polivenok1,2, William M Novick2,3, Aleksander V Pyetkov4
1Zaitcev V.T. Institute of General and Urgent Surgery, Kharkiv, Ukraine.
Insights
Failure-to-rescue significantly increases operative mortality in pediatric cardiac surgery in low-resource settings. Improving rescue rates is crucial for reducing deaths in these vulnerable populations.
Area of Science:
- Pediatric Cardiac Surgery
- Global Health Equity
- Surgical Outcomes Research
Background:
- Perioperative complications and failure-to-rescue rates in pediatric cardiac surgery are poorly understood in low- and middle-income countries (LMICs).
- Limited systemic resources in LMICs may exacerbate the impact of complications on patient outcomes.
Purpose of the Study:
- To assess the rate of perioperative complications in pediatric cardiac surgery.
- To evaluate mortality associated with these complications.
- To identify patient demographics and procedural risk factors contributing to complications and death.
Main Methods:
- Retrospective single-center study of 296 consecutive pediatric cardiac surgery patients.
- Analysis of risk factors for perioperative complications and operative mortality.
- Statistical assessment of complication rates, mortality, and predictor variables.
Main Results:
- Overall mortality was 5.7%; 24.7% of patients experienced 145 perioperative complications, leading to 17 operative deaths.
- A higher number of complications strongly correlated with increased mortality (p = 0.007).
- Risk factors included younger age, prior surgery, extracardiac anomalies, comorbidities, and cardiopulmonary bypass; complication count predicted operative death.
Conclusions:
- Failure-to-rescue is a significant driver of operative mortality in pediatric cardiac surgery within resource-limited settings.
- Operative mortality for patients with perioperative complications was higher in this LMIC series compared to developed nations.
- Targeted initiatives are necessary to enhance failure-to-rescue capabilities in LMICs.
Background:
The perioperative complications rate in paediatric cardiac surgery, as well as the failure-to-rescue impact, is less known in low- and middle-income countries.
Aim:
To evaluate perioperative complications rate, mortality related to complications, different patients' demographics, and procedural risk factors for perioperative complication and post-operative death.
Methods:
Risk factors for perioperative complications and operative mortality were assessed in a retrospective single-centre study which included 296 consecutive children undergoing cardiac surgery.
Results:
Overall mortality was 5.7%. Seventy-three patients (24.7%) developed 145 perioperative complications and had 17 operative mortalities (23.3%). There was a strong association between the number of perioperative complications and mortality - 8.1% among patients with only 1 perioperative complication, 35.3% - with 2 perioperative complications, and 42.1% - with 3 or more perioperative complications (p = 0.007). Risk factors of perioperative complications were younger age (odds ratio 0.76; (95% confidence interval 0.61, 0.93), previous cardiac surgery (odds ratio 3.5; confidence interval 1.33, 9.20), extracardiac structural anomalies (odds ratio 3.03; confidence interval 1.27, 7.26), concomitant diseases (odds ratio 3.23; confidence interval 1.34, 7.72), and cardiopulmonary bypass (odds ratio 6.33; confidence interval 2.45, 16.4), whereas the total number of perioperative complications per patient was the only predictor of operative death (odds ratio 1.89; confidence interval 1.06, 3.37).
Conclusions:
In a program with limited systemic resources, failure-to-rescue is a major contributor to operative mortality in paediatric cardiac surgery. Despite the comparable crude mortality, the operative mortality among patients with perioperative complications in our series was significantly higher than in the developed world. A number of initiatives are needed in order to improve failure-to-rescue rates in low- and middle-income countries.
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