ArticleBrazilian journal of cardiovascular surgery2025
Quality and Safety Initiatives in a Pediatric and Congenital Heart Surgery Program in a Lowand Middle-Income Country: The Impact of International Collaboration.
Article in Brazilian journal of cardiovascular surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionThis study assessed the impact of a quality and safety (Q&S) improvement program on outcomes in pediatric and congenital heart surgery (PCHS) through an international non-governmental collaboration in a low-and-middle-income country (LMIC).
methodsSurgical data from two distinct periods, PRE (January 2016 - December 2019) and POST (January 2020 - May 2024) Q&S implementation, were analyzed. Outcomes included 30-day mortality, urgency status, patient age, and procedure complexity using the Risk Adjustment for Congenital Heart Surgery (RACHS) 1 classification.
resultsA total of 4,297 surgeries were performed: 2,429 in the PRE and 1,868 in the POST era. Overall, 30-day mortality decreased significantly from 7.5% to 5.1% (P = 0.002), reaching 3.1% in 2024. Urgent surgeries increased from 28% to 44% (P < 0.0001), while mortality in elective and urgent cases dropped from 3.9% to 1.7% (P = 0.0007) and from 16.5% to 9.6% (P < 0.0001), respectively. A shift toward more neonatal and infant cases was observed, with significant reductions in mortality in both groups (P = 0.01). Case mix complexity also increased (RACHS categories 3-6), yet mortality declined across all RACHS strata.
conclusionThe introduction of Q&S initiatives led to marked improvements in PCHS outcomes, even amid growing case complexity and acuity. These findings highlight the value of structured protocols and sustained Q&S efforts and underscore the transformative role of international partnerships in strengthening surgical care in LMICs.
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