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Infrastructure Availability for the Care of Congenital Heart Disease Patients and Its Influence on Case Volume, Complexity and Access Among Healthcare Institutions in 17 Middle-Income Countries Cover

Infrastructure Availability for the Care of Congenital Heart Disease Patients and Its Influence on Case Volume, Complexity and Access Among Healthcare Institutions in 17 Middle-Income Countries

Global Heart
Volume 16 (2021): Issue 1
By: Isaac Wamala,  Russell Gongwer,  Kaitlin Doherty-Schmeck,  Maria Jorina,  Anne Betzner,  Bistra Zheleva,  Kimberlee Gauvreau,  Christopher W. Baird and  Kathy Jenkins  
Open Access
|Oct 2021
Figures & tables

Figures & Tables

Figure 1

Availability of medication, blood products, surgical supplies and implants.

Table 1

Infrastructure for pre and post-operative in-patient care.

Infrastructure VariableFacilities (N = 37)
ICU availability for paediatric CHD patientsPaediatric cardiac dedicated
Shared with adult
Shared with other paediatric		22 (60%)
12 (32%)
3 (8%)
ICU availability for adult CHD ptsAdult CHD Pts. go to paediatric cardiac ICU;
Adult CT ICU;
Other		17 (46%)
15 (41%)
3 (13%)
Neonatal ICU (NICU) available14 (38%)
Ventilators for Neonates available36 (97%)
High Frequency Oscillators available20 (54%)
Incubators available29 (78%)
Warming tables (N = 36)30 (83%)
Dedicated code cart (N = 36)33 (92%)
Emergency code cart fully stocked with all necessary medications33 (89%)
Paediatric formulations of medication available for code cartAll code carts;
Some;
None		18 (55%)
8 (24%)
7 (21%)
Sterile emergency instruments available in ICU30 (81%)
ECMO/or MCS programme20 (54%)
Attending surgeon usually present for patient transport28 (76%)
Formal multidisciplinary handover from OR to ICU regularly done33 (89%)
Attending level physician responsible for post-op ICU management of CHD patientsCardiac Intensivist
General Intensivist
Cardiac Surgeon
Paediatrician
Neonatologist		28 (76%)
3 (8%)
2 (5%)
2 (5%)
2 (5%)
Formal ICU Rounds regularly conducted at least once daily
Dedicated CHD Care coordinators available		37 (100%)
16 (43%)
Social workers available24 (65%)
Multidisciplinary case meetings/or roundsRegular Scheduled Multi-Disciplinary Rounds18 (49%)
Multi-Disciplinary Rounds/ Meetings as needed
No Regular Multi-Disciplinary rounds		17 (46%)
2 (5%)
An intermediate care ward18 (50%)
Figure 2

Number of programs that expressed limitations in specific areas of clinical care.

Figure 3

Aggregated limitation themes mentioned as free text.

Table 2

Association of case volume and case complexity mix with selected infrastructure.

VariableCase Volume (N = 37)Case Complexity Mix (N = 34)
Number of SitesMedian [IQR] number of surgical cases per yearP-value/or Spearman r (P-value)Number of SitesMedian [IQR] Percent of Cases with RACS 3–6P-value/or Spearman r (P-value)
Country Income Group 20180.170.04
    Upper Middle20272 [165, 569]2037 [28,45]
    Lower Middle17381 [293, 680]1424 [20,31]
Type of Facility0.460.48
    Public24381 [207, 760]2231 [20,45]
    Private6264 [170, 361]534 [24,37]
    NPO7369 [261, 530]730 [0,37]
Associated with Medical School0.210.67
    Yes28311 [207, 622]2631 [20,41]
    No9530 [361, 1126]834 [21, 46]
Operating room availability0.0070.02
CHD dedicated, or shared but with ≥3 ORs26455 [261, 688]2337 [24, 45]
OR Shared and 1 or 2 ORs11210 [101, 339]1123 [17, 30]
CPB machine availability0.110.54
CHD dedicated, or shared but with ≥3 machines26365 [234, 759]2331 [21, 42]
CPB Shared and 1 or 2 machines11261 [113, 529]1130 [7, 48]
Availability of bypass packs, cardioplegia tubing, arterial and venous cannula0.330.38
    Always (for all 3)31369 [210, 688]3032 [21, 42]
    Not always6272 [170, 548]423 [13, 36]
Number of surgeons0.49 (0.002)0.18 (0.31)
    1–28219 [112, 277]822 [18, 44]
    3–415380 [195, 653]1430 [21, 37]
    ≥514560 [339, 1057]1234 [27, 47]
Years of experience, most senior surgeon0.030.25
    ≤108213 [124, 248]725 [19, 30]
    >1029381 [282, 680]2734 [20, 43]
Number of OR nurses0.44 (0.008)0.12 (0.51)
    <410205 [110, 328]1036 [26, 45]
    4–815381 [204, 673]1325 [18, 41]
    ≥911380 [339, 760]1034 [23, 38]
Number of cardiac anaesthesiologists0.34 (0.04)0.28 (0.11)
    <416277 [200, 517]1526 [18, 42]
    4–612375 [222, 635]1031 [21, 45]
    ≥79530 [282, 1428]934 [30, 37]
Number of perfusionists0.53 (<0.001)0.14 (0.44)
    <416237 [200, 381]1530 [19, 41]
    4–514350 [170, 680]1231 [19, 47]
    ≥671126 [653, 2865]736 [21, 43]
Number of cardiologists0.24 (0.15)0.49 (0.004)
    <514277 [195, 548]1225 [12, 32]
    5–912381 [207, 907]1234 [20, 43]
    ≥1010365 [328, 760]936 [31, 48]
Years of experience, most senior cardiologist0.050.56
    ≤107215 [170, 293]628 [20, 34]
    >1028455 [261, 684]2632 [21, 42]
Number of ICU nurses0.75 (<0.001)0.15 (0.39)
    <1511195 [110, 361]1032 [24, 45]
    15–3912311 [222, 375]1125 [19, 42]
    ≥4014720 [548, 1126]1332 [21, 38]
ICU bed capacity0.76 (<0.001)0.22 (0.20)
    ≤614183 [110, 234]1326 [23, 30]
    7–1510381 [282, 673]932 [17, 41]
    ≥1613680 [529, 1126]1237 [26, 46]
Distance travelled for surgery
(percent of patients)
    > 200 km280.04 (0.83)260.02 (0.94)
Table 3

Association of key infrastructure to proportion of estimated new case burden performed.

Percentage of Estimated Needed Case Volume
Number of SitesMedian [IQR] proportion of estimated case volume fulfilledP-value/or Spearman r (P-value)
Operating room availability0.11
CHD dedicated, or shared but with ≥3 ORs261.02 [0.29 1.27]
OR Shared and 1 or 2 ORs110.60 [0.16, 0.79]
Number of surgeons0.37 (0.025)
    1–280.61 [0.19, 1.03]
    3–4150.59 [0.16, 1.12]
    ≥5141.17 [0.59, 1.46]
Number of OR nurses0.04 (0.83)
    <4100.96 [0.19, 1.27]
    4–8150.59 [0.09, 0.93]
    ≥9110.66 [0.25, 1.97]
Number of cardiac anaesthesiologists0.33 (0.049)
    <4160.63 [0.14, 1.13]
    4–6120.53 [0.34, 1.03]
    ≥791.24 [0.65, 2.16]
Number of perfusionists0.37 (0.025)
    <4160.60 [0.32, 0.86]
    4–5140.74 [0.09, 1.28]
    ≥671.24 [0.40, 2.75]
Number of cardiologists0.39 (0.019)
    <5140.62 [0.09, 1.21]
    5–9120.53 [0.24, 1.02]
    ≥10101.19 [0.66, 1.97]
Number of ICU nurses0.42 (0.009)
    <15110.44 [0.14, 1.11]
    15–39120.63 [0.14, 1.02]
    ≥40141.22 [0.47, 1.28]
ICU bed capacity0.52 (0.001)
    ≤6140.46 [0.16, 0.66]
    7–15100.86 [0.14, 1.21]
    ≥16131.24 [0.63, 1.97]
GNI per Capita370.36 (0.030)
DOI: https://doi.org/10.5334/gh.968 | Journal eISSN: 2211-8179
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Language: English
Submitted on: Dec 1, 2020
Accepted on: Aug 31, 2021
Published on: Oct 21, 2021
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year
Keywords:
Congenital Heart Surgery,
Infrastructure,
Surgical Capacity

© 2021 Isaac Wamala, Russell Gongwer, Kaitlin Doherty-Schmeck, Maria Jorina, Anne Betzner, Bistra Zheleva, Kimberlee Gauvreau, Christopher W. Baird, Kathy Jenkins, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

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