A Team-Based Approach to Surgical and Anaesthetic Care for Children with Congenital Heart Disease in a Low Resource Setting in Ghana West Africa
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Background: Congenital heart disease (CHD) is one of the leading causes of perinatal and infant death from congenital malformations. Incidence of CHD ranges from 6 to13 cases per 1,000 live births with a higher absolute number in developing countries. The insufficient infrastructure adds to the list of obstacles to open-heart surgery (OHS) in this region. Africa has one centre for 50 million inhabitants. Komfo Anokye Teaching Hospital (KATH), Kumasi provide surgical and perioperative care to CHD patients going for OHS from Ashanti region, other regions of Ghana as well as neighbouring countries. Practising OHS in such a resource-poor setting has peculiar challenges. The purpose of this study was to describe the types of surgeries performed in last ten years, to compare the change in trends before and after 2014, to assess the efficiency and quality of care provided by the cardiac anesthesiologist in the delivery of this care in a low resource setting in Ghana.
Methods: This study was performed through retrospective chart review cared from 2007 to 2016. 118 patients from either sex, undergoing elective OHS under general anaesthesia were selected for the study. Patients with insufficient data were excluded from the relevant analysis. Institutional approval for the study was obtained from the Komfo Anokye Teaching Hospital committee on human research publications and ethics.
Results: Demographic profile of the study population as patient age, weight, body surface area were 5.65 ± 1.03 years, 16.92± 0.67 Kg and 0.58 ± 0.13 m2 respectively. The male to female ratio was 1:1.75. Mortality percentage 2.5% with Aristotle comprehensive complexity (ACC) mean of 7.1 that represents to ACC level 2. Postoperative percentage of patients extubated in the operating room were 7.2% and 39.2% before 2014 and after 2014 which statistically significantly improved in after 2014 (P<0.05). The duration of postoperative mechanical ventilator support in hours, average ICU Length Of Stay (LOS) in days, and average hospital LOS in days were (82.35±11.71 and 23.49±7.93), (3.15±2.37 and 1.37±2.85), and (6.86±3.50 and 4.21±3.67) before 2014 and after 2014 respectively. Postoperative chest tube drainage in the first 48 hours was significantly less after 2014 (95 ± 20.3 ml) as compared with before 2014 (133 ± 28.4 ml).
Conclusion: Cardiac anaesthesiologists were an essential part of a team, who provided safe and effective perioperative care in KATH to over 100 Ghanaian children with advanced CHD. Efforts by the cardiac anaesthesia team to avoid anaesthetic complications by the selection of simple cases, minimize post-operative bleeding through aggressive use of tranexamic acid, on-table extubation and rational use of inotropic drugs. All contributed to the efficient and cost-effective care of these patients in this low resource environment. Given its success in serving as a model for others those wish to develop a program aimed at providing surgical care for patients with congenital heart disease in low resource environments.
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