Excellent Cardiac Surgical Outcomes in Paediatric Indigenous Patients, but Follow-up Difficulties

Background: Indigenous Australians' infant mortality is three times that of non-Indigenous Australians. Indigenous children's mortality from rheumatic heart disease is 17-21 times that of non-Indigenous male and female children, respectively. No studies have looked specifically at the operative outcomes of cardiac surgery in paediatric Indigenous patients in Australia and little is known about their follow-up. Aims: To describe operative outcomes of all Indigenous paediatric cardiac surgical patients at a single Australian tertiary hospital and assess their follow-up. Methods: Database review of retrospectively collected data of all Indigenous paediatric patients who had cardiac surgery performed at The Prince Charles Hospital, Brisbane between 2002 and 2009 (112 patients, 123 operations). Followup was assessed by chart review and time to first post-discharge echocardiogram recorded in the hospital database. Results: Eighty-one percent of operations were congenital heart disease related and 19% of operations were rheumatic heart disease related. Common co-morbidities included respiratory (9.7%) and renal dysfunction (0.8%). Common complications were, bleeding/tamponade 4.1%, cardiac arrest 4.1% and new atrial arrhythmia 2.4%. Mortality was 1% for congenital operations and 4.4% for rheumatic operations. Only 33% of patients had follow-up within eight weeks documented through letters or chart entry. Only 77.5% of patients had a documented follow-up echocardiogram. Discussion: Operative outcome in Indigenous paediatric patients is similar to that found in the global literature. The follow-up for such an excellent surgical outcome has been disappointing. A coordinated action within and between health, health related and social institutions with sufficient resources will assist. (Heart, Lung and Circulation 2010;19:517-522) Crown Copyright (C) 2010 Published by Elsevier Inc. on behalf of Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. All rights reserved.