Liječnički vjesnik, Vol. 137 No. 11-12, 2015.
Original scientific paper
CROATIAN POPULATION AND CLINICAL EPIDEMIOLOGICAL STUDIES OF CONGENITAL HEART DISEASE (1995–2011): THE USE OF ABC SCORE AND RACHS-1 CARDIOSURGICAL MODEL FOR THE ASSESSMENT OF QUALITY OF TREATMENT OF CONGENITAL HEART DISEASE
Ivan Malčić
Daniel Dilber
Hrvoje Kniewald
Darko Anić
Dražen Belina
Dalibor Šarić
Dorotea Bartoniček
Alen Hodalin
Andrea Dasović-Buljević
Sanja Dorner
Vitomir Metličić
Karmen Markičević
Marija Sršen-Krstulović
Abstract
Aim: 1. To present an epidemiological (population and clinical) study of congenital heart defects (CHD) in Croatia in a 16-year period (1995–2011). 2. To analyze outcomes of surgical procedures for all patients in a five-year period (2002–2007) and to compare the results between Croatian and foreign centers. 3. To present the progress in surgical care of CHD in Croatia while acknowledging the requirement of achieving postsurgical mortality rate of below 5%. 4. To evaluate the projection of positive development of CHD management in Croatia in cooperation with major cardiac surgical centers in the neighboring countries. Methods: Population study includes all children born from 1995 to 2000 and from 2002 to 2007 included in a database modeled by EUROCAT and BWIS. Outcome analysis was made using two models (ABC and RACHS-1) with early mortality rating and prolonged length of stay. Results: Based on two separate studies, mean value of CHD prevalence in Croatia is 7.6 ‰. Outcome analysis according to the two mentioned evaluation models for the 2002–2007 period shows that children operated on in Croatia had a lower level of complexity compared to the complexity of those sent to foreign centers, but early mortality was below the assigned margin of 5% and there were also no differences in prolonged length of stay. As much as 63% of surgeries in the period were performed abroad, while the remaining 37% were performed in Croatia (351:202). In the following four-year period (2008–2011) there was a significant increase in the number of surgeries performed in Croatia when compared to those performed abroad (59:4% or 380:264). Independent EACTS analysis points to a positive trend of gradual increase in the number of surgeries and acceptance of higher complexity level of surgeries performed in Croatia, while maintaining the assigned margin (early mortality below 5%). Contribution: Proper selection of patients according to the complexity of cardiac surgical procedure is a prerequisite for both low mortality and fewer postsurgical complications. Professional advance relying on close cooperation with foreign centers is much faster and more acceptable than by »learning curves«. Conclusion: Pediatric cardiac surgery in the developing countries must rely on the experiences of developed cardiac surgical centers in the neighboring countries due to complexity of congenital heart defects. Pediatric cardiology is inherently a public health problem, but the problem exacerbates with the appearance of a large number of adults with congenital heart defects (GUCH patients).
Keywords
Brain neoplasms – diagnosis, drug therapy; Pathology, radiotherapy, surgery; Glioma – diagnosis, drug therapy; Pathology, radiotherapy, surgery; Astrocytoma – diagnosis, drug therapy; Pathology, radiotherapy, surgery; Glioblastoma – diagnosis, drug therapy; Pathology, radiotherapy, surgery; Combined modality therapy; Practice guidelines as topic; Croatia
Hrčak ID:
172738
URI
Publication date:
28.12.2015.
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