期刊论文详细信息
Improvement in congenital heart surgery in a developing country - The Guatemalan experience
Article
关键词: CATEGORIES REFLECT MORTALITY;    PEDIATRIC CARDIAC-SURGERY;    IN-HOSPITAL MORTALITY;    RISK ADJUSTMENT;    CHILDREN;    DISEASE;    POPULATION;    LENGTH;    STAY;   
DOI  :  10.1161/CIRCULATIONAHA.107.695403
来源: SCIE
【 摘 要 】

Background - In 1997, an effort was made to disseminate US pediatric cardiac surgical practices to create a new comprehensive program in Guatemala. The objective of this study was to describe the improvement of the program by exploring the reduction in risk-adjusted in-hospital mortality. Methods and Results - A retrospective cohort study of surgical procedures performed in Guatemala from February 1997 to July 2004 was conducted. Data were divided into 3 time periods ( 1997 to 1999, 2000 to 2002, and 2003 to 2004) and compared with a US benchmark ( 2000 Kids' Inpatient Database of 27 states and 313 institutions). The risk adjustment for congenital heart surgery ( RACHS-1) method was used to adjust for case mix. Mortality rates, standardized mortality ratios, and 95% confidence intervals were calculated. A total of 1215 surgical procedures were included. Median age was 3.1 years ( range, 1 day to 17.9 years). The overall mortality was 10.7% ( n = 130). The RACHS-1 method showed better discrimination than in prior reports ( area under receiver operating characteristic curve = 0.854). A decreasing trend in mortality rate was observed in every RACHS-1 risk category over the 3 time periods. When compared against the US benchmark, the reduction in risk-adjusted mortality was noted by a decrease of standardized mortality ratio from 10.0 ( 95% confidence interval, 7.2 to 13.7) in 1997-1999, to 7.8 ( 95% confidence interval, 5.9 to 10.0) in 2000-2002, and to 5.7 ( 95% confidence interval, 3.8 to 8.3) in 2003-2004. Conclusions - In a short time period, mortality after congenital heart surgery has been reduced substantially in Guatemala. Measurement of risk-adjusted mortality is a useful method to assess pediatric cardiac program improvement in the developing world.

【 授权许可】

Free   

  文献评价指标  
  下载次数:0次 浏览次数:0次