| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
J Thorac Cardiovasc Surg 2007;134:765-771
© 2007 The American Association for Thoracic Surgery
Surgery for Congenital Heart Disease |
a Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Center, Kerala, India
b Department of Biostatistics, Amrita Institute of Medical Sciences and Research Center, Kerala, India
c Department of Pediatric Cardiac Surgery, Amrita Institute of Medical Sciences and Research Center, Kerala, India
d Department of Cardiac Anesthesia, Amrita Institute of Medical Sciences and Research Center, Kerala, India
e Department of Pediatrics, Stanford University School of Medicine, and Lucile Packard Children’s Hospital, Palo Alto, Calif.
Received for publication March 19, 2007; revisions received April 12, 2007; accepted for publication April 23, 2007. * Address for reprints: Balu Vaidyanathan, MD, DNB, (Pediatrics), DM (Cardiology), Pediatric Cardiology, Amrita Institute of Medical sciences, Elamakkara P.O., Kochi, Kerala, India Pin: 682 026. (Email: baluvaidyanathan{at}aims.amrita.edu; baluvaidyanathan{at}gmail.com).
Objective: Significant technologic advances have improved outcomes in neonatal cardiac surgery over the past 3 decades. However, outcomes might be different in developing countries with resource limitations. We sought to identify the determinants of early outcome after neonatal cardiac surgery in a tertiary referral center in South India.
Methods: Hospital records of 330 consecutive neonates who underwent surgical intervention between January 1999 and April 2006 were reviewed, and perioperative variables were recorded. Main outcome measures were 30-day mortality, postoperative bloodstream infection, and hospital stay of longer than 10 days. Multivariate logistic regression analysis was performed.
Results: Overall mortality was 8.8%. Mortality significantly decreased from 21.4% before 2002 to 4.3% after 2002 (3.2% for corrective operations, P < .0001). The prevalence of postoperative bloodstream infection remained the same, whereas surgical site infection and hospital stay significantly increased after 2002. Predictors of outcomes on multivariate analysis were as follows: (1) mortality—operation before 2002 (odds ratio, 5.5), age less than 7 days (odds ratio, 3.8), preoperative antibiotic use (odds ratio, 5.6), and postoperative exchange transfusion (odds ratio, 14.9); (2) postoperative bloodstream infection (21.2%)—use of cardiopulmonary bypass (odds ratio, 2.0), reintubation (odds ratio, 7.7), and surgical site infection (odds ratio, 4.1); and (3) hospital stay of longer than 10 days (61.2%)—use of cardiopulmonary bypass (odds ratio, 2.8), delayed sternal closure (odds ratio, 3.6), reintubation (odds ratio, 12.1), surgical site infection (odds ratio, 13.8), and postoperative antibiotic use (odds ratio, 4.4).
Conclusions: With increasing experience, neonatal cardiac surgery can be performed with excellent outcomes in developing countries with resource limitations. Infectious complications contribute significantly to morbidity and mortality, and improvements in infection-control practices should be emphasized to improve outcomes further.
This article has been cited by other articles:
|
|
 |
|
  R K Kumar and S Shrivastava Paediatric heart care in India Heart, August 1, 2008; 94(8): 984 - 990. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
