Surgical Outcome for Tetralogy of Fallot in an African Setting; a Tanzanian Experience Using Retrospective Analysis of Hospital Data

Abstract

Background: Tetralogy of Fallot (TOF) is typically treated in infancy but often done late in many resource-limited countries, jeopardizing surgical outcomes. This study examined the results of TOF repair surgery at the Jakaya Kikwete Cardiac Institute (JKCI) in Tanzania, an emerging cardiac centre in Eastern Africa. Methods: A retrospective cohort study of children <18 years with TOF post-surgical repair between 2019 and 2021 was conducted. Data on socio-demography, pre-and postoperative cardiac complications, Intensive Care Unit (ICU) and hospital stay, and in-hospital and 30-day mortality were analyzed. Logistic regressions were employed to find the factors for mortality, ICU, and hospital stays. Results: The I07 children operated on were majority male (62.3%), with a median age of 3.0 years (IQR: 2- 6). Almost all (90%) were underweight, with a mean BMI of 14.6 + 3.1 kg/m2. Only 18.7% were below one year of age. Haematocrits were high, with a median of 48.7 (IQR: 37.4-59.0). Bacterial sepsis was more common than surgical site infection (5.6% vs 0.9%). The median oxygen saturation was 81% (IQR:72-93). The median ICU stay was 72 hours (IQR:48-120), with ICU duration exceeding three days for most patients. The median hospital stay was 8.5 days (IQR:7-11), with 66% experiencing an extended hospital stay of > 7 days. The in-hospital mortality rate was 10.3%, with no deaths occurring in children less than one year of age nor after discharge during the 30-day follow-up period. No statistically significant differences were observed in outcomes in relation to clinical and demographic characteristics. Conclusion: TOF repairs in an African setting face challenges associated with patients' older age and compromised nutritional status during the surgery. Perioperative mortality rates and morbidity for patients operated at an older age remain elevated. It’s important to address these issues to improve outcomes in these settings.