Factors associated with poor outcomes after congenital heart surgery in low-resource setting in Pakistan: insight from the IQIC Registry – a descriptive analysis
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 Disease...
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BMJ Publishing Group
2023-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/12/e078884.full |
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| author | Muneer Amanullah Abdul Sattar Shaikh Shumaila Furnaz Musa Karim Rayyan Qureshi Subhani Fatima Sohail Khan Bangash |
| author_facet | Muneer Amanullah Abdul Sattar Shaikh Shumaila Furnaz Musa Karim Rayyan Qureshi Subhani Fatima Sohail Khan Bangash |
| author_sort | Muneer Amanullah |
| collection | DOAJ |
| description | 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%). |
| format | Article |
| id | doaj-art-d084e3b9c32e41cd9bf374047b37b466 |
| institution | DOAJ |
| issn | 2044-6055 |
| language | English |
| publishDate | 2023-12-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-d084e3b9c32e41cd9bf374047b37b4662025-08-20T03:11:04ZengBMJ Publishing GroupBMJ Open2044-60552023-12-01131210.1136/bmjopen-2023-078884Factors associated with poor outcomes after congenital heart surgery in low-resource setting in Pakistan: insight from the IQIC Registry – a descriptive analysisMuneer Amanullah0Abdul Sattar Shaikh1Shumaila Furnaz2Musa Karim3Rayyan Qureshi4Subhani Fatima5Sohail Khan Bangash6National Institute of Cardiovascular Diseases, Karachi, PakistanNational Institute of Cardiovascular Diseases, Karachi, PakistanNational Institute of Cardiovascular Diseases, Karachi, PakistanNational Institute of Cardiovascular Diseases, Karachi, PakistanNational Institute of Cardiovascular Diseases, Karachi, PakistanNational Institute of Cardiovascular Diseases, Karachi, PakistanNational Institute of Cardiovascular Diseases, Karachi, PakistanObjective 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%).https://bmjopen.bmj.com/content/13/12/e078884.full |
| spellingShingle | Muneer Amanullah Abdul Sattar Shaikh Shumaila Furnaz Musa Karim Rayyan Qureshi Subhani Fatima Sohail Khan Bangash Factors associated with poor outcomes after congenital heart surgery in low-resource setting in Pakistan: insight from the IQIC Registry – a descriptive analysis BMJ Open |
| title | Factors associated with poor outcomes after congenital heart surgery in low-resource setting in Pakistan: insight from the IQIC Registry – a descriptive analysis |
| title_full | Factors associated with poor outcomes after congenital heart surgery in low-resource setting in Pakistan: insight from the IQIC Registry – a descriptive analysis |
| title_fullStr | Factors associated with poor outcomes after congenital heart surgery in low-resource setting in Pakistan: insight from the IQIC Registry – a descriptive analysis |
| title_full_unstemmed | Factors associated with poor outcomes after congenital heart surgery in low-resource setting in Pakistan: insight from the IQIC Registry – a descriptive analysis |
| title_short | Factors associated with poor outcomes after congenital heart surgery in low-resource setting in Pakistan: insight from the IQIC Registry – a descriptive analysis |
| title_sort | factors associated with poor outcomes after congenital heart surgery in low resource setting in pakistan insight from the iqic registry a descriptive analysis |
| url | https://bmjopen.bmj.com/content/13/12/e078884.full |
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