Paediatrics and Child Health; Surgery
Background: The nature of complications and outcomes for Ventricular septal defect (VSD) repair differ between developed and developing countries. Understanding these differences can help optimize patient management according to geographical location.
Objective: The purpose of this study was to investigate the risk factors associated with in-hospital peri- and post-surgical complications of VSD repair in a developing country.
Design: A retrospective cohort study. Setting: A tertiary referral center. Participants: 117 patients under 18 years of age admitted for surgical closure of ventricular septal defect between July 1998 and June 2008.
Main Outcomes: Only patients with isolated VSD or VSD associated with acyanotic congenital heart disease were included. Outcomes were defined as in-hospital minor and major complications and mortality.
Results: Adverse complications occurred in 35.9% (42/117) and death in 3.4% (4/117) of cases. Age >12 months (OR 0.17 13 months-5 years; 0.10 5-18 years), weight >10 kg (OR 0.24 11-20 kg; 0.13>21 kg), and absence of pulmonary artery hypertension (OR 0.43) were all significantly associated with a reduced rate of adverse events. A longer stay in intensive care unit/semi-intensive care unit (OR 11.6 5-7 days; OR 6.1 >8 days) and larger size of ventricular septal defect (OR 5.4 medium size; 3.9 large size) were associated with an increased risk of adverse events. Infection (20%) and pneumonia (10%) were the commonest complications.
Conclusions and relevance: Age under one year, weight less than ten kilograms, pulmonary artery hypertension, and moderate to large size ventricular septal defect are more likely to be associated with adverse outcomes after surgical repair of ventricular septal defect. Infection and pneumonia comprise almost one third of the total complications, compared to higher arrhythmic events in developed countries. Developing countries have a distinct spectrum of complications that may be avoidable and treatable.
Journal of Clinical and Experimental Cardiology
(2013). Surgical outcomes of pediatric patients with ventricular septal defects in a tertiary referral center in Pakistan: a retrospective cohort study. Journal of Clinical and Experimental Cardiology, 4(10), 1-5.
Available at: http://ecommons.aku.edu/pakistan_fhs_mc_women_childhealth_paediatr/240