Determinants of early outcome after neonatal cardiac surgery in a developing country

Kinjal D. Bakshi, Balu Vaidyanathan, Karimassery R. Sundaram, Stephen J. Roth, Krishnanaik Shivaprakasha, Suresh G. Rao, Suresh G. Nair, Suresh Chengode, R. Krishna Kumar

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Objective: Significant technologic advances have improved outcomes in neonatal cardiac surgery over the past 3 decades. However, outcomes might be different in developing countries with resource limitations. We sought to identify the determinants of early outcome after neonatal cardiac surgery in a tertiary referral center in South India. Methods: Hospital records of 330 consecutive neonates who underwent surgical intervention between January 1999 and April 2006 were reviewed, and perioperative variables were recorded. Main outcome measures were 30-day mortality, postoperative bloodstream infection, and hospital stay of longer than 10 days. Multivariate logistic regression analysis was performed. Results: Overall mortality was 8.8%. Mortality significantly decreased from 21.4% before 2002 to 4.3% after 2002 (3.2% for corrective operations, P < .0001). The prevalence of postoperative bloodstream infection remained the same, whereas surgical site infection and hospital stay significantly increased after 2002. Predictors of outcomes on multivariate analysis were as follows: (1) mortality-operation before 2002 (odds ratio, 5.5), age less than 7 days (odds ratio, 3.8), preoperative antibiotic use (odds ratio, 5.6), and postoperative exchange transfusion (odds ratio, 14.9); (2) postoperative bloodstream infection (21.2%)-use of cardiopulmonary bypass (odds ratio, 2.0), reintubation (odds ratio, 7.7), and surgical site infection (odds ratio, 4.1); and (3) hospital stay of longer than 10 days (61.2%)-use of cardiopulmonary bypass (odds ratio, 2.8), delayed sternal closure (odds ratio, 3.6), reintubation (odds ratio, 12.1), surgical site infection (odds ratio, 13.8), and postoperative antibiotic use (odds ratio, 4.4). Conclusions: With increasing experience, neonatal cardiac surgery can be performed with excellent outcomes in developing countries with resource limitations. Infectious complications contribute significantly to morbidity and mortality, and improvements in infection-control practices should be emphasized to improve outcomes further.

Original languageEnglish
Pages (from-to)765-771
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume134
Issue number3
DOIs
Publication statusPublished - Sep 2007

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Developing Countries
Thoracic Surgery
Odds Ratio
Surgical Wound Infection
Mortality
Length of Stay
Cardiopulmonary Bypass
Infection
Anti-Bacterial Agents
Hospital Records
Infection Control
Tertiary Care Centers
India
Multivariate Analysis
Logistic Models
Regression Analysis
Outcome Assessment (Health Care)
Morbidity

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Bakshi, K. D., Vaidyanathan, B., Sundaram, K. R., Roth, S. J., Shivaprakasha, K., Rao, S. G., ... Kumar, R. K. (2007). Determinants of early outcome after neonatal cardiac surgery in a developing country. Journal of Thoracic and Cardiovascular Surgery, 134(3), 765-771. https://doi.org/10.1016/j.jtcvs.2007.04.042

Determinants of early outcome after neonatal cardiac surgery in a developing country. / Bakshi, Kinjal D.; Vaidyanathan, Balu; Sundaram, Karimassery R.; Roth, Stephen J.; Shivaprakasha, Krishnanaik; Rao, Suresh G.; Nair, Suresh G.; Chengode, Suresh; Kumar, R. Krishna.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 134, No. 3, 09.2007, p. 765-771.

Research output: Contribution to journalArticle

Bakshi, KD, Vaidyanathan, B, Sundaram, KR, Roth, SJ, Shivaprakasha, K, Rao, SG, Nair, SG, Chengode, S & Kumar, RK 2007, 'Determinants of early outcome after neonatal cardiac surgery in a developing country', Journal of Thoracic and Cardiovascular Surgery, vol. 134, no. 3, pp. 765-771. https://doi.org/10.1016/j.jtcvs.2007.04.042
Bakshi, Kinjal D. ; Vaidyanathan, Balu ; Sundaram, Karimassery R. ; Roth, Stephen J. ; Shivaprakasha, Krishnanaik ; Rao, Suresh G. ; Nair, Suresh G. ; Chengode, Suresh ; Kumar, R. Krishna. / Determinants of early outcome after neonatal cardiac surgery in a developing country. In: Journal of Thoracic and Cardiovascular Surgery. 2007 ; Vol. 134, No. 3. pp. 765-771.
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abstract = "Objective: Significant technologic advances have improved outcomes in neonatal cardiac surgery over the past 3 decades. However, outcomes might be different in developing countries with resource limitations. We sought to identify the determinants of early outcome after neonatal cardiac surgery in a tertiary referral center in South India. Methods: Hospital records of 330 consecutive neonates who underwent surgical intervention between January 1999 and April 2006 were reviewed, and perioperative variables were recorded. Main outcome measures were 30-day mortality, postoperative bloodstream infection, and hospital stay of longer than 10 days. Multivariate logistic regression analysis was performed. Results: Overall mortality was 8.8{\%}. Mortality significantly decreased from 21.4{\%} before 2002 to 4.3{\%} after 2002 (3.2{\%} for corrective operations, P < .0001). The prevalence of postoperative bloodstream infection remained the same, whereas surgical site infection and hospital stay significantly increased after 2002. Predictors of outcomes on multivariate analysis were as follows: (1) mortality-operation before 2002 (odds ratio, 5.5), age less than 7 days (odds ratio, 3.8), preoperative antibiotic use (odds ratio, 5.6), and postoperative exchange transfusion (odds ratio, 14.9); (2) postoperative bloodstream infection (21.2{\%})-use of cardiopulmonary bypass (odds ratio, 2.0), reintubation (odds ratio, 7.7), and surgical site infection (odds ratio, 4.1); and (3) hospital stay of longer than 10 days (61.2{\%})-use of cardiopulmonary bypass (odds ratio, 2.8), delayed sternal closure (odds ratio, 3.6), reintubation (odds ratio, 12.1), surgical site infection (odds ratio, 13.8), and postoperative antibiotic use (odds ratio, 4.4). Conclusions: With increasing experience, neonatal cardiac surgery can be performed with excellent outcomes in developing countries with resource limitations. Infectious complications contribute significantly to morbidity and mortality, and improvements in infection-control practices should be emphasized to improve outcomes further.",
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