Reducing Mortality and Infections After Congenital Heart Surgery in the Developing World abstract

BACKGROUND: There is little information about congenital heart surgery outcomes in developing countries. The International Quality Improvement Collaborative for Congenital Heart Surgery in Developing World Countries uses a registry and quality improvement strategies with nongovernmental organization reinforcement to reduce mortality. Registry data were used to evaluate impact. METHODS: Twenty-eight sites in 17 developing world countries submitted congenital heart surgery data to a registry, received annual benchmarking reports, and created quality improvement teams. Webinars targeted 3 key drivers: safe perioperative practice, infection reduction, and teambased practice. Registry data were audited annually; only verified data were included in analyses. Risk-adjusted standardized mortality ratios (SMRs) and standardized infection ratios among participating sites were calculated. RESULTS: Twenty-seven sites had verified data in at least 1 year, and 1 site withdrew. Among 15 049 cases of pediatric congenital heart surgery, unadjusted mortality was 6.3% and any major infection was 7.0%. SMRs for the overall International Quality Improvement Collaborative for Congenital Heart Surgery in Developing World Countries were 0.71 (95% confidence interval [CI] 0.62–0.81) in 2011 and 0.76 (95% CI 0.69–0.83) in 2012, compared with 2010 baseline. SMRs among 7 sites participating in all 3 years were 0.85 (95% CI 0.71–1.00) in 2011 and 0.80 (95% CI 0.66–0.96) in 2012; among 14 sites participating in 2011 and 2012, the SMR was 0.80 (95% CI 0.70–0.91) in 2012. Standardized infection ratios were similarly reduced. CONCLUSIONS: Congenital heart surgery risk-adjusted mortality and infections were reduced in developing world programs participating in the collaborative quality improvement project and registry. Similar strategies might allow rapid reduction in global health care disparities. Pediatrics 2014;134:e1422–e1430 AUTHORS: Kathy J. Jenkins, MD, MPH,a Aldo R. Castañeda, MD, PhD,b K.M. Cherian, MD,c Chris A. Couser, MHA,a Emily K. Dale, MPH, CHES,d Kimberlee Gauvreau, ScD,a Patricia A. Hickey, PhD, MBA, RN, FAAN,a Jennifer Koch Kupiec, MPH,a Debra Forbes Morrow, RN,a William M. Novick, MD,e,f Shawn J. Rangel, MD, MSCE,a Bistra Zheleva, MBA,d and Jan T. Christenson, MD, PhDg aBoston Children’s Hospital, Boston, Massachusetts; bUnidad de Cirugía Cardiovascular Pediátrica de Guatemala, Guatemala City, Guatemala; cFrontier Lifeline Hospital, Chennai, India; dChildren’s HeartLink, Minneapolis, Minnesota; eInternational Children’s Heart Foundation, Memphis, Tennessee; fUniversity of Tennessee Health Sciences Center, Memphis, Tennessee; and gUniversity Hospital Geneva, Geneva, Switzerland