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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Factors associated with poor outcomes after congenital heart surgery in low-resource setting in Pakistan: insight
Shumaila Furnaz1, Abdul Sattar Shaikh2, Rayyan Qureshi2
1National Institute of Cardiovascular Diseases, Karachi, Pakistan shumailafurnaz41@gmail.com.
Insights
This study found high rates of infection and mortality in pediatric congenital heart surgery patients in Pakistan. Low oxygen saturation and high surgical risk scores were linked to increased mortality.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Global Health
Background:
- Congenital heart disease (CHD) surgery outcomes vary globally.
- Developing countries face unique challenges in managing CHD surgical care.
- Data from Pakistan's National Institute of Cardiovascular Diseases provides insight into CHD surgical trends.
Purpose of the Study:
- To analyze single-site International Quality Improvement Collaborative data from Pakistan.
- To identify trends in surgical outcomes for congenital heart disease (CHD).
- To determine factors associated with poor outcomes in CHD surgery.
Main Methods:
- Retrospective descriptive study of 3367 CHD surgical cases.
- Analysis of preoperative, procedural, demographic data, and complications.
- Multivariable logistic regression to identify risk factors for mortality and sepsis.
Main Results:
- In-hospital mortality was 6.7%, with 4.4% experiencing bacterial sepsis.
- Low oxygen saturation (<85%) and higher Risk Adjustment for Congenital Heart Surgery (RACHS-1) categories (3-6) increased mortality risk.
- Teenagers had lower mortality compared to infants/children.
Conclusions:
- High prevalence of postoperative infections and mortality observed.
- Infancy/childhood, low oxygen saturation, and high RACHS-1 categories are significant risk factors.
- Targeted interventions are needed for high-risk pediatric CHD surgical patients.
Objective:
This study aimed to assess the International Quality Improvement Collaborative single-site data from a developing country to identify trends in outcomes and factors associated with poor outcomes.
Design:
Retrospective descriptive study.
Setting:
The National Institute of Cardiovascular Diseases, Karachi, Pakistan.
Participants:
Patients undergoing surgery for congenital heart disease (CHD).
Outcome Measure:
Key factors were examined, including preoperative, procedural and demographic data, as well as surgical complications and outcomes. We identified risk factors for mortality, bacterial sepsis and 30-day mortality using multivariable logistic regression.
Results:
A total of 3367 CHD surgical cases were evaluated; of these, 59.4% (2001) were male and 82.8% (2787) were between the ages of 1 and 17 years. Only 0.2% (n=6) were infants (≤30 days) and 2.3% (n=77) were adults (≥18 years). The in-hospital mortality rate was 6.7% (n=224), and 4.4% (n=147) and 0.8% (n=27) had bacterial sepsis and surgical site infections, respectively. The 30-day status was known for 90.8% (n=3058) of the patients, of whom 91.6% (n=2800) were alive. On multivariable analysis, the adjusted OR for in-hospital mortality was 0.40 (0.29-0.56) for teenagers compared with infancy/childhood and 1.95 (1.45-2.61) for patients with oxygen saturation <85%. Compared with Risk Adjustment for Congenital Heart Surgery (RACHS-1) risk category 1, the adjusted OR for in-hospital mortality was 1.78 (1.1-2.87) for RACHS-1 risk category 3 and 2.92 (1.03-8.31) for categories 4-6. The adjusted OR for 30-day mortality was 0.40 (0.30-0.55) for teenagers and 1.52 (1.16-1.98) for patients with oxygen saturation <85%. The 30-day mortality rate was significantly higher in RACHS-1 risk category 3 compared with category 1, with an adjusted OR of 1.64 (1.06-2.55).
Conclusions:
We observed a high prevalence of postoperative infections and mortality, especially for high-risk procedures, according to RACHS-1 risk category, in infancy/childhood, in children with genetic syndrome or those with low oxygen saturation (<85%).
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