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Outcomes After Bidirectional Glenn Shunt in a Tertiary-Care Pediatric Hospital in South Africa
Heidi M Meyer1, Danai Marange-Chikuni2, MMed Anaesthesia2
1Division of Paediatric Anaesthesia, Department of Anaesthesia & Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
Insights
Outcomes after bidirectional Glenn surgery (BDG) in children from a low-income country showed a 3.3% mortality rate and high complication rates, primarily infections. Longer ICU and hospital stays were linked to complications, with a significant loss to follow-up.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease Management
- Global Health Outcomes Research
Background:
- Limited data exists on bidirectional Glenn surgery (BDG) outcomes in low- and middle-income countries (LMICs).
- Existing research primarily focuses on high-income countries, leaving a gap in understanding BDG in diverse healthcare settings.
- This study addresses the need for LMIC-specific data on postoperative complications and outcomes following BDG.
Purpose of the Study:
- To evaluate in-hospital postoperative complications in children undergoing bidirectional Glenn surgery (BDG).
- To identify factors associated with complications and their impact on patient outcomes.
- To provide crucial data on BDG outcomes from a tertiary hospital in a low-income country.
Main Methods:
- Retrospective cohort study involving 61 children (<18 years) who underwent BDG surgery.
- Data collected over 8 years at a tertiary teaching hospital.
- Primary outcome: in-hospital postoperative complications assessed by predefined criteria.
Main Results:
- 57.4% of patients experienced at least one postoperative complication, with infections being the most frequent (29.5%).
- Complications were associated with longer pediatric intensive care unit (ICU) and hospital stays.
- Older age at BDG, nitric oxide use, and longer anesthesia/surgery durations were linked to complications in univariate analysis.
Conclusions:
- Bidirectional Glenn surgery in this LMIC cohort had an acceptable mortality rate (3.3%) but a high complication rate, notably infections.
- Complications significantly increased ICU and hospital lengths of stay.
- A high rate of patients (30.5%) were lost to follow-up, highlighting challenges in long-term outcome assessment in this setting.
Objectives:
Large data sets have been published on short- and long-term outcomes following bidirectional Glenn surgery (BDG), or partial cavopulmonary connection, in high-income countries. Data from low-income and middle-income countries are few and often limited to the immediate postoperative period. The primary outcome was any in-hospital postoperative complication, assessed according to predefined criteria, in children who underwent BDG surgery at Red Cross War Memorial Children's Hospital.
Design:
A retrospective cohort study.
Setting:
A tertiary teaching hospital.
Participants:
The study authors identified 61 children (<18 years of age) who underwent BDG over 8 years. The median age of patients undergoing BDG was 2.5 years (interquartile range, 1.4-5.5 years).
Interventions:
BDG surgery.
Measurements And Main Results:
Thirty-five patients (57.4%) had a postoperative complication, with some patients (17 of 61, 27.9%) having more than 1 complication. The most frequent complications were infective (29.5%). Univariate analysis found that postoperative complications were associated with the use of nitric oxide (p = 0.004) and a longer duration of anesthesia (p = 0.045) and surgery (p = 0.004). Patients with complications spent longer in the pediatric intensive care unit (ICU) (p < 0.001) and in the hospital (p < 0.012). On multivariate analysis, a priori risk factors based on previous studies were not found to be statistically significant. A total of 37.3% of patients completed their single-ventricle palliation, and 30.5% of patients were lost to follow-up.
Conclusions:
Important findings were the older age at which the BDG was performed compared to high-income countries, an acceptable mortality rate of 3.3%, infection being the most common complication, the association of a complication with increased ICU and hospital lengths of stay, and the high rate of patients lost to follow-up.
