TY - JOUR
T1 - Results of international assistance for a paediatric heart surgery programme in a single Ukrainian centre
AU - Polivenok, Igor V.
AU - Molloy, Frank J.
AU - Gilbert, Christian L.
AU - Danton, Mark
AU - Dodge-Khatami, Ali
AU - Rao, Sri O.
AU - Breinholt, John P.
AU - Cardarelli, Marcelo
AU - Penk, Jamie S.
AU - Novick, William M.
N1 - Publisher Copyright:
© 2019 Cambridge University Press.
PY - 2019/3/1
Y1 - 2019/3/1
N2 - Background Surgery for CHD has been slow to develop in parts of the former Soviet Union. The impact of an 8-year surgical assistance programme between an emerging centre and a multi-disciplinary international team that comprised healthcare professionals from developed cardiac programmes is analysed and presented.Material and methods The international paediatric assistance programme included five main components - intermittent clinical visits to the site annually, medical education, biomedical engineering support, nurse empowerment, and team-based practice development. Data were analysed from visiting teams and local databases before and since commencement of assistance in 2007 (era A: 2000-2007; era B: 2008-2015). The following variables were compared between periods: annual case volume, operative mortality, case complexity based on Risk Adjustment for Congenital Heart Surgery (RACHS-1), and RACHS-adjusted standardised mortality ratio.Results A total of 154 RACHS-classifiable operations were performed during era A, with a mean annual case volume by local surgeons of 19.3 at 95% confidence interval 14.3-24.2, with an operative mortality of 4.6% and a standardised mortality ratio of 2.1. In era B, surgical volume increased to a mean of 103.1 annual cases (95% confidence interval 69.1-137.2, p<0.0001). There was a non-significant (p=0.84) increase in operative mortality (5.7%), but a decrease in standardised mortality ratio (1.2) owing to an increase in case complexity. In era B, the proportion of local surgeon-led surgeries during visits from the international team increased from 0% (0/27) in 2008 to 98% (58/59) in the final year of analysis.Conclusions The model of assistance described in this report led to improved adjusted mortality, increased case volume, complexity, and independent operating skills.
AB - Background Surgery for CHD has been slow to develop in parts of the former Soviet Union. The impact of an 8-year surgical assistance programme between an emerging centre and a multi-disciplinary international team that comprised healthcare professionals from developed cardiac programmes is analysed and presented.Material and methods The international paediatric assistance programme included five main components - intermittent clinical visits to the site annually, medical education, biomedical engineering support, nurse empowerment, and team-based practice development. Data were analysed from visiting teams and local databases before and since commencement of assistance in 2007 (era A: 2000-2007; era B: 2008-2015). The following variables were compared between periods: annual case volume, operative mortality, case complexity based on Risk Adjustment for Congenital Heart Surgery (RACHS-1), and RACHS-adjusted standardised mortality ratio.Results A total of 154 RACHS-classifiable operations were performed during era A, with a mean annual case volume by local surgeons of 19.3 at 95% confidence interval 14.3-24.2, with an operative mortality of 4.6% and a standardised mortality ratio of 2.1. In era B, surgical volume increased to a mean of 103.1 annual cases (95% confidence interval 69.1-137.2, p<0.0001). There was a non-significant (p=0.84) increase in operative mortality (5.7%), but a decrease in standardised mortality ratio (1.2) owing to an increase in case complexity. In era B, the proportion of local surgeon-led surgeries during visits from the international team increased from 0% (0/27) in 2008 to 98% (58/59) in the final year of analysis.Conclusions The model of assistance described in this report led to improved adjusted mortality, increased case volume, complexity, and independent operating skills.
KW - CHD
KW - international assistance
KW - outcomes
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U2 - 10.1017/S1047951118002457
DO - 10.1017/S1047951118002457
M3 - Article
C2 - 30813981
AN - SCOPUS:85062395026
SN - 1047-9511
VL - 29
SP - 363
EP - 368
JO - Cardiology in the young
JF - Cardiology in the young
IS - 3
ER -