Impact of Partnership Between Children’s HeartLink and IQIC Database With a Pediatric Cardiology and Cardiovascular Surgery Center in Brazil

Abstract

Background: Aiming at fostering local development of cardiology and cardiovascular surgery centers in developing countries, the nonprofit organization Children's HeartLink (CHL) encourages centers to participate in the International Quality Improvement Collaborative Database for Congenital Heart Disease (IQIC). The definition of parameters and data to evaluate patient treatment provides an opportunity to improve quality of care, reducing morbidity and mortality. The objective of the study was to analyze the outcomes of the partnership between CHL and IQIC database with a single pediatric cardiology and cardiovascular surgery center for seven years providing continuous follow-up to guide actions aiming at morbidity and mortality reduction in patients with pediatric and congenital heart diseases. Methods: Data were collected from January 2011 to December 2017 independently and with external audits and included preoperative information (demographic data, nutritional status, chromosomal abnormalities), Risk Adjustment for Congenital Heart Surgery (RACHS-1) score, and postoperative information such as infections or complications within the first 30 days or until hospital discharge and/or death. Results: In the preoperative period, there was a trend toward an increase in the number of newborn patients. The postoperative period showed significant surgical procedure variations between groups for RACHS-1 risk category (P ¼ .003), prevalence of risk categories 2 and 3, and an increase in risk categories 4, 5, and 6, mainly in the last two years. Decreases in surgical site infection (P ¼ .03), bacterial sepsis, and other infections (both P < .001) were observed. At the 30-day postoperative follow-up, there was a decrease of inhospital (P ¼ .16) and 30-day (P ¼ .14) mortality. Conclusion: The partnership between CHL and this seven-year analysis of IQIC database demonstrated structural and human flaws, whose resolution led to significant decrease in infection and reduction in mortality despite an increase in the complexity of our pediatric and congenital heart disease population.

50 Years of Children’s HeartLink and the Partnerships in Brazil

“…We, the representatives of Brazil, have experienced firsthand the benefits of this partnership between Children's HeartLink and our hospitals, with significant improvements in the quality of care we provide to our patients, increase in our multidisciplinary team expertise, as well as in the number of children treated. We are encouraged to see the leadership and accountability with which Children's HeartLink thinks about the future of pediatric cardiac services around the world, and we are even more confident and hopeful about new possible partnerships with other pediatric cardiac centers in our country [5,6] .…”

The Search for Data, the Only True Justice

“…In this edition of the World Journal for Pediatric and Congenital Heart Surgery , Croti and associates describe outcomes from the collaboration between Children’s Heart Link (CHL) and a Brazilian congenital heart program. 4 Children’s Heart Link is a nonprofit organization established in 1969 with the joint aims of providing developing congenital heart programs with the ability to improve overall surgical results and facilitating interactions with global medical professionals volunteering their time and expertise. Bringing highly trained medical professionals into resource-limited areas allows nascent programs to learn via exchange of operative experience and continuous lines of communication.…”

“…In the article “Impact of a Partnership between Children’s Heart Link and the IQIC Database with a Pediatric Cardiology and Cardiovascular Surgery Center in Brazil,” the authors explore the effectiveness of using this strategy to evaluate and document the success of one such collaboration. 4 Beginning in 2010, the Pediatric Cardiology and Cardiovascular Surgery Center of the Sao Jose do Rio Preto Medical School in Sao Paulo, Brazil partnered with the Mayo Clinic and Children’s Hospital and Clinics of Minnesota, both CHL-affiliated congenital heart programs. At the time, all operative cases performed by the teams were entered in the IQIC database, resulting in the collection of data for 1202 surgical cases over seven years.…”

Fatores de risco para infecção da ferida operatória em pacientes submetidos à cirurgia cardíaca pediátrica

“…4,6,17,18 Estudo americano tipo caso controle de Costello et al 6 Murakami 22 , em sua dissertação de mestrado intitulada "Impacto da parceria entre banco de dados internacional e centro único de cardiologia e cirurgia cardiovascular pediátrica de referência no Brasil", demonstrou a diminuição significativa de infecções, incluindo infecção do sítio cirúrgico (taxa de ISC reduziu de 7% para 1%, p=0,03), através da análise do banco de dados da IQIC realizada durante sete anos. 23 O papel crucial dos programas de controle de infecção hospitalar, principalmente em países com recursos financeiros limitados, foi demonstrado em estudos de Singh et al 24 (2012) e de Huskins et al 25 Na década de 90, Huskins et al 25 Sendo assim, a padronização de medidas de vigilância e de controle de infecção aliada ao treinamento e disseminação de informação é uma forma custo-efetiva para redução das IRAS e aprimoramento dos resultados após cirurgia cardíaca pediátrica.…”

“…Collaborative for Congenital Heart Disease categoriza a faixa etária dos pacientes submetidos a cirurgia cardíaca em congênita em ≤30 dias, 31 dias a menor que um ano, de um a 17 anos e ≥18 anos. [21][22][23] A faixa etária neonatal foi excluída deste estudo, pois já se tem conhecimento da imaturidade do sistema imune e da maior suscetibilidade a infecções. Os recém-nascidos possuem menor número de células apresentadoras de antígenos, redução da quimiotaxia de neutrófilos e monócitos, menor atividade do sistema complemento e perfil diferente de citocinas em relação aos adultos.…”