IMPACT OF INTERNATIONAL COLLABORATION ON IMPROVING PEDIATRIC CARDIAC SERVICES AT AFIC/NIHD, RAWALPINDI

Abstract

Objective: This study assessed the program by measuring improvement in the surgical result of the
institution.

Study Design: Retrospective analytical study.

Place and Duration of Study: International Children’s heart Foundation (ICHF) in 2005 to 2009.

Material and Methods: During 04 years (2005 to 2009), ICHF team made 15 educational trips working
alongside local team. The study compared surgical results of 03 years prior to the program (Era A) with 04
years during the program (Era B) and 03 years (Era C) after the program. Risk Adjustment for Congenital
Heart Surgery (RACHS-1) scheme was used for risk adjustment. Mixed and risk adjusted in-hospital
mortality along with standardized mortality ratio was calculated for each era. Chi square statistics were used
as a test of significance.

Results: A total of 4709 cases were assigned to a risk adjustment for congenital heart surgery (RACHS-1) risk
category. Case numbers increased significantly across the three time periods (p < 0.001). RACHS-I complexity
increased from 1.76 to 2.16 by the end of “Era B” and to 2.07 in “Era C”. Mixed mortality decreased
significantly from 12.03% in “Era A” to 9.76%during “Era B” to 7.01% in “Era C” (p=0.03). Mortality decreased
significantly in each RACHS-I category. Standardized mortality ratio improved from 3.65 in ‘Era A” to 1.81 in
“Era B” to 1.31 during “Era C” (p < 0.001), amounting to 127 deaths avoided among 3637 patients in 7 years.

Conclusion: Reduction in mixed and risk adjusted mortality with improvement in standardized mortality
ratio validated the ...