Managing congenital and pediatric cardiac surgery database: the impact on clinical practice and quality of care
Monitoring patient care outcomes is essential to ensure quality of care, identification of areas of deficiency and for evaluation of strategies designed to overcome those weaknesses.
METHODS:
The Cardiothoracic surgery division maintains a computerized database of all the patients since July 2006, 1236 patients operated between July 2006 and Sep 2013 was analyzed. Major analysis included in-hospital and 30 day mortality and morbidity.
RESULTS:
Out of a total of 1236 heart surgeries, the most common open heart surgeries were VSD 27%, TOF 24% were, and 13% were ASD. In closed heart 51% were Modified BT shunts, 17% were PDA. The overall 30-day mortality in open heart was 7.0%, and in closed heart it was 7.3%. Post-surgery more common complication in open heart surgery was prolong ventilation which was 39%,arrhythmias 14%,reopenings 11% and sepsis 5%total morbidity was 29% while in closed heart most common complication was prolong ventilation which was 31%. Readmissions after 30 day of Discharge were 8.4% mainly for respiratory infection. Followed with 14% lost to follow-ups 85% patients were alive, 0.6% were died at 30 day patients follow up.
Changes
TOF; initial mortality and morbidity was on the higher side of normal range first change was leaving a 3-4 mm PFO which include survival and incidence of LCOS subsequently reconstructing the PV decreased the PR resulting in early extubation and improving survival.VSD on table extubation minimal morbidity and early discharges.ASD on table extubation
CONCLUSIONS:
Maintained database helped to identify deficiencies, strength and trends of the Pediatric and Congenital Cardiac surgery program at our hospital and also to design strategies for continuing improvement in patient care. Also provides scientific evidence for comparing results with other institutions of the region and world.