Cardiac surgery in low-income settings: 10 years of experience from two countries.

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Cardiac surgery in low-income settings: 10 years of experience from two countries.


JournalArchives for cardiovascular diseases
Publication date – Feb – 2017
Authors – Mirabel M, Lachaud M, Offredo L, Lachaud C, Zuschmidt B, Ferreira B, Sidi D, Chauvaud S, Sok P, Deloche A, Marijon E, Jouven X
KeywordsNGO
Open access – Yes
SpecialityCardiothoracic surgery
World region Eastern Africa, South-eastern Asia
Country: Cambodia, Mozambique
Language – English
Submitted to the One Surgery Index on June 30, 2018 at 10:35 pm
Abstract:

BACKGROUND:
Access to cardiac surgery is limited in low-income settings, and data on patient outcomes are scarce.

AIMS:
To assess characteristics, surgical procedures and outcomes in patients undergoing open-heart surgery in low-income settings.

METHODS:
This was a cohort study (2001-2011) in two low-income countries, Cambodia and Mozambique, where cardiac surgery had been promoted by visiting non-governmental organizations.

RESULTS:
In Cambodia and Mozambique, respectively, 1332 and 767 consecutive patients were included; 547 (41.16%) and 385 (50.20%) were men; median age at first surgery was 11 years (interquartile range [IQR] 4-14) and 11 years (IQR 3-18); rheumatic heart disease affected 490 (36.79%) and 268 (34.94%) patients; congenital heart disease (CHD) affected 834 (62.61%) and 390 (50.85%) patients, with increasingly more CHD patients over time (P<0.001); and the number of patients lost to follow-up reached 741 (55.63%) and 112 (14.6%) at 30 days. A total of 249 (32.46%) patients were lost to follow-up in Mozambique, remoteness being the only influencing factor (P<0.001). Among patients with known vital status, the early (<30 days) postoperative mortality rate was 6.10% (n=40) in Mozambique and 3.05% (n=18) in Cambodia. Overall, 109 (8.18%) patients in Cambodia and 94 (12.26%) patients in Mozambique underwent re-do surgery. In Mozambique, a further 50/518 (9.65%) patients died at a median of 23months (IQR 7-43); in Cambodia, a further 34/591 (5.75%) patients died at a median of 11.5months (IQR 6-54.5).

CONCLUSIONS:
Cardiac surgery is feasible in low-income countries with acceptable in-hospital mortality and proof of capacity building. Patient outcomes after cardiac surgery in low-income countries remain unknown, given the strikingly high numbers of lost to follow-up

OSI Number – 10007
PMID – 27720166

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