Paediatric cardiac surgery in a peripheral European region: is a joint programme a safe alternative to regionalisation?

Iacona, Gabriele M.; Giamberti, Alessandro; Abella, Raúl; Pomè, Giuseppe; Agredo, J; Mendieta, Saúl G.; Forcano, Antonio; Sobrado, Concepción; Suárez, J.L. Méndez; Peñate, Sonia; Melián, Asunción; Volo, M.; González, Rafael; Antúnez, Marisa L.; Falcón, Hipólito; Cabrera, Francisco; Rubio, Carlos; Fernández, Javier; Suárez, Pedro Rodríguez; Perera, César; Frigiola, Alessandro

doi:10.1017/s1047951116000469

Cited by 5 publications

(5 citation statements)

References 21 publications

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“…European joint programs between small-and larger-volume centers for pediatric cardiac surgery have been effective in this area. 26 The current study has several limitations. Individual surgeon volumes of pediatric surgeries could not be measured from KID.…”

Section: Anesthesia and Analgesiamentioning

confidence: 90%

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Hospital Volumes of Inpatient Pediatric Surgery in the United States

Berry

Rodean

Leahy³

et al. 2021

Anesthesia &Amp; Analgesia

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BACKGROUND: Perioperative outcomes of children depend on the skill and expertise in managing pediatric patients, as well as integration of surgical, anesthesiology, and medical teams. We compared the types of pediatric patients and inpatient surgical procedures performed in low- versus higher-volume hospitals throughout the United States. METHODS: Retrospective analysis of 323,258 hospitalizations with an operation for children age 0 to 17 years in 2857 hospitals included in the Agency for Healthcare Research and Quality (AHRQ) Kids’ Inpatient Database (KID) 2016. Hospitals were categorized by their volume of annual inpatient surgical procedures. Specific surgeries were distinguished with the AHRQ Clinical Classification System. We assessed complex chronic conditions (CCCs) using Feudtner and Colleagues’ system. RESULTS: The median annual volume of pediatric inpatient surgeries across US hospitals was 8 (interquartile range [IQR], 3–29). The median volume of inpatient surgeries for children with a CCC was 4 (IQR, 1–13). Low-volume hospitals performed significantly fewer types of surgeries (median 2 vs 131 types of surgeries in hospitals with 1–24 vs ≥2000 volumes). Appendectomy and fixation of bone fracture were among the most common surgeries in low-volume hospitals. As the volume of surgical procedures increased from 1 to 24 to ≥2000, the percentage of older children ages 11 to 17 years decreased (70.9%–32.0% [P < .001]) and the percentage of children with a CCC increased (11.2%–60.0% [P < .001]). CONCLUSIONS: Thousands of US hospitals performed inpatient surgeries on few pediatric patients, including those with CCCs who have the highest risk of perioperative morbidity and mortality. Evaluation of perioperative decision making, workflows, and pediatric clinicians in low- and higher-volume hospitals is warranted.

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Section: Anesthesia and Analgesiamentioning

confidence: 90%

“…European joint programs between small- and larger-volume centers for pediatric cardiac surgery have been effective in this area. 26…”

Section: Discussionmentioning

confidence: 99%

Hospital Volumes of Inpatient Pediatric Surgery in the United States

Berry

Rodean

Leahy³

et al. 2021

Anesthesia &Amp; Analgesia

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“…Accidental extubation with frequent reintubation and errors in preparation of medications seem to be the most common errors found in prolonged mechanical ventilation or ICU stays. Whenever possible, one-to-one model pairing between the local team and visiting team members, as well as same-site recurring voluntary visits, should be done in order to properly assess the development of the local team achievement (11).…”

Section: Discussionmentioning

confidence: 99%

Humanitarian Mission in Pediatric Cardiothoracic Surgery: A Recipient's Perspective

Zain¹,

Shamsuddin²,

Mamat³

et al. 2019

Front. Pediatr.

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Introduction: Pediatric cardiac surgical mission programs are deemed as common practice, especially in developing nations funded by international non-governmental organizations (NGOs). This article presents and discusses the results and strategies implemented by this partnership, aiming at achieving the autonomy of the local center by this collaboration. Materials and Methods: A retrospective review was conducted on patients with congenital heart disease who underwent surgical intervention from the beginning of the NGO collaboration (September 2015) until November 2018 in an existing cardiac center. In between those visits, any congenital heart disease patient with Risk Adjustment Congenital Heart Surgery (RACHS)-1 Category 1–3 would be discussed in a local multi-disciplinary meeting with regards to the feasibility of the surgery being performed by the local members. Results: A total of 60 operations were performed during the trips. Throughout the visit, 46% (28) of the operations were performed by the local surgeon, with or without assistance from the visiting surgeon. Between September 2015 and November 2018, 27 cases were also performed by the local team independently. For the 27 cases performed by the local team independently, the median age of the patient was 42 days (ranging from 14 days to 20 years old), with median body weight of 3.2 kg (ranging from 2.8 to 64 kg). Conclusion: Humanitarian pediatric cardiac surgical missions are safe to be done for the population in need. In order to achieve autonomy, continuous efforts by both teams are crucial, as the cooperation by the two parties ensures that the objectives are achieved.

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“…There is lively debate regarding the organization of the distribution of healthcare centers involved in CHD care [25], especially regarding which organizational characteristics and competencies are needed to be a CHD specialist center, because the whole care process for these patients is very challenging [26]. Approximately 500 patients with CHD are surgically treated every year in PSD; 368 of them are under 18 years old and 41 patients are 11-18 years old (i.e.…”

Section: The Chd Transition Care Model Implementation At Psd: Experiementioning

confidence: 99%

Towards the Standardization of Transition Care Models for Adolescents with Congenital Heart Disease (CHD): A Perspective

Flocco¹,

Caruso²,

Dellafiore³

et al. 2017

J Clin Exp Cardiolog

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This perspective paper is aimed to describe an Italian experience related to the empirical implementation of Congenital Heart Disease (CHD) transition care models, highlighting the most significant author's perspectives. The CHD transition care models implementation strategy adopted at Policlinico San Donato (Italy) is closely linked to the clinical practice and to the research activity at national and international level. This strategy could be an efficient start-up to boost the understanding of the adolescent patients' needs, also giving more evidence to the effectiveness of the transition care models.

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Paediatric cardiac surgery in a peripheral European region: is a joint programme a safe alternative to regionalisation?

Abstract: A joint programme between a small-volume centre and a large-volume centre may represent a valid and reproducible model for safe paediatric cardiac surgery in the context of a peripheral region.

Cited by 5 publications

References 21 publications

Hospital Volumes of Inpatient Pediatric Surgery in the United States

Hospital Volumes of Inpatient Pediatric Surgery in the United States

Humanitarian Mission in Pediatric Cardiothoracic Surgery: A Recipient's Perspective

Towards the Standardization of Transition Care Models for Adolescents with Congenital Heart Disease (CHD): A Perspective

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