Establishing a High-Quality Pediatric Cardiac Surgery Program in Post-Conflict Regions: A Model for Limited Resource
Tammam Youssef1, Fouad Bitar2, Hassanain Alogla3
1, San Donato Milanese-Milano, Italy.
Insights
Establishing a pediatric cardiac surgery program in Iraq through international collaboration yielded a 4.1% surgical mortality rate, comparable to global standards. This partnership model offers a sustainable approach for limited-resource nations.
Area of Science:
- Cardiovascular Surgery
- Global Health
- Pediatric Cardiology
Background:
- Congenital Heart Disease (CHD) is a major cause of infant mortality globally.
- Significant disparities exist in surgical outcomes between high-income and low- to middle-income countries.
- Limited resources and post-conflict settings exacerbate challenges in pediatric cardiac care.
Purpose of the Study:
- To establish a high-quality Pediatric Cardiac Surgery Program in Iraq, a post-conflict, limited-resource country.
- To evaluate a collaborative partnership model between a local governmental entity and an international private organization.
- To assess the feasibility and outcomes of in situ pediatric cardiac surgery.
Main Methods:
- A descriptive retrospective study analyzed 148 pediatric cardiac surgery procedures.
- Procedures were performed by a visiting surgical team from October 2021 to October 2022.
- The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STS-EACTS) Congenital Heart Surgery Database (CHSD) complexity scoring model (STAT) was used to assess mortality risk.
Main Results:
- 144 patients underwent 148 procedures, with infants comprising 58.3%.
- Common diagnoses included Tetralogy of Fallot, Ventricular Septal Defect, and single ventricle anomalies (76% of cases).
- The overall surgical mortality rate was 4.1%, with an observed/expected mortality ratio of 1.1 (95% CI 0.5, 2.3), not significantly different from STS-EACTS Database benchmarks.
Conclusions:
- A collaborative model involving public infrastructure commitment and private clinical/training services can establish sustainable, high-quality in situ pediatric cardiac surgery programs.
- This approach is viable for upper-middle-income countries with limited resources.
- The program demonstrated comparable surgical outcomes to international standards while being more cost-effective than overseas treatment.
Background:
Congenital Heart Disease stands as a prominent cause of infant mortality, with notable disparities in surgical outcomes evident between high-income and low- to middle-income countries.
Objective:
This study presents a collaborative partnership between a local governmental entity and an international private organization to establish a high-quality Pediatric Cardiac Surgery Program in a post-conflict limited resource country, Iraq.
Methods:
A descriptive retrospective study analyzed pediatric cardiac surgery procedures performed by a visiting pediatric heart surgery team from October 2021 to October 2022, funded by the Ministry of Health (MOH). We used the STS-EACTS complexity scoring model (STAT) to assess mortality risks associated with surgical procedures.
Results:
A total of 144 patients underwent 148 procedures. Infants comprised 58.3% of the patients. The most common anomalies included tetralogy of Fallot, ventricular septal defect, and various single ventricle categories, constituting 76% of the patient cohort. The overall surgical mortality rate was 4.1%, with an observed/expected surgical mortality rate of 1.1 (95% CI 0.5, 2.3). There was no significant difference between our observed surgical mortality in Category 2, 3, and 4 and those expected/reported by the STS-EACTS Database (p = 0.07, p = 0.72, and p = 0.12, respectively). The expenses incurred by the MOH for conducting surgeries in Iraq were lower than the alternative of sending patients abroad for the same procedures.
Conclusion:
The partnership model between a local public entity committed to infrastructure development and funding and an international private organization delivering clinical and training services can provide the foundation for building sustainable, high-quality in situ programs in upper-middle-income countries.
Related Concept Videos
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
01:30Primary Healthcare Services
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
01:30Specialized Care Centers and Settings-II
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
01:26Kidney Transplant II: Surgical Procedure