Hospital Mortality and Adverse Events Following Repair of Congenital Heart Defects in Developing Countries.

IF 1.1 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS World Journal for Pediatric and Congenital Heart Surgery Pub Date : 2023-11-01 Epub Date: 2023-06-29 DOI:10.1177/21501351231176189
Brian P Bateson, Luqin Deng, Brittany Ange, Erle Austin, Robert Dabal, Taylor Broser, John Pennington, Sivalingam Sivakumar, Cheul Lee, Nguyen Ly Thinh Truong, Jeffery P Jacobs, Jorge Cervantes, James K Kirklin, James St Louis
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Abstract

Background: Mortality associated with the correction of congenital heart disease has decreased to approximately 2% in developed countries and major adverse events are uncommon. Outcomes in developing countries are less well defined. The World Database for Pediatric and Congenital Heart Surgery was utilized to compare mortality and adverse events in developed and developing countries.

Methods: A total of 16,040 primary procedures were identified over a two-year period. Centers that submitted procedures were dichotomized to low/middle income (LMI) and high income (HI) by the Gross National Income per capita categorization. Mortality was defined as any death following the primary procedure to discharge or 90 days inpatient. Multiple logistic regression models were utilized to identify independent predictors of mortality.

Results: Of the total number of procedures analyzed, 83% (n  =  13,294) were from LMI centers. Among all centers, the mean age at operation was 2.2 years, with 36% (n  =  5,743) less than six months; 85% (n  =  11,307) of procedures were STAT I/II for LMI centers compared with 77% (n = 2127) for HI centers (P < .0001). Overall mortality across the cohort was 2.27%. There was a statistical difference in mortality between HI centers (0.55%) versus LMI centers (2.64%) (P < .0001). After adjustment for other risk factors, the risk of death remained significantly higher in LMI centers (odds ratio: 2.36, 95% confidence interval: 1.707-3.27).

Conclusion: Although surgical expertise has increased across the globe, there remains a disparity with some outcomes associated with the correction of congenital heart disease between developing and developed countries. Further studies are needed to identify specific opportunities for improvement.

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发展中国家先天性心脏缺陷修复后的医院死亡率和不良事件
背景:在发达国家,与先天性心脏病矫正相关的死亡率已降至约2%,重大不良事件并不常见。发展中国家的成果没有得到很好的界定。世界儿科和先天性心脏外科数据库用于比较发达国家和发展中国家的死亡率和不良事件。方法:在两年的时间里,共确定了16040个主要程序。根据人均国民总收入分类,提交程序的中心被分为低/中等收入(LMI)和高收入(HI)。死亡率被定义为出院或住院90天后的任何死亡。采用多元逻辑回归模型来确定死亡率的独立预测因素。结果:在分析的手术总数中,83%(n  =  13294)来自LMI中心。在所有中心中,手术时的平均年龄为2.2岁,其中36%(n  =  5743)少于六个月;85%(n  =  11307例)LMI中心为STAT I/II,而HI中心为77%(n=2127)(P P 结论:尽管全球外科专业知识有所增加,但发展中国家和发达国家在先天性心脏病矫正方面的一些结果仍存在差异。需要进一步研究,以确定具体的改进机会。
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CiteScore
1.80
自引率
11.10%
发文量
128
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