title: Pediatric heart surgery waiting time in Thailand and its effect on mortality: A cooperative study from Chulalongkorn, Children and Chiang Mai University hospitals.
abstract: BACKGROUND
  Thai children who need cardiac surgery are often put on a waiting list. The waiting time and mortality during waiting have not been previously systematically studied.
  
  
  METHODS
  A cooperative study was conducted at King Chulalongkorn Memorial hospital (Chula), Children hospital (CH), and Chiang Mai University hospital (CMU). The status of children who were referred for cardiac surgery at these hospitals in the year 1999-2000 (Chula and CMU) and the year 2000 (CH) were analyzed by Kaplan-Meier survival curve. The patients who lost to follow up and could not be contacted were censored at the time of last clinic visit. Log-Rank test was used to compare the survival curve and waiting time between three hospitals.
  
  
  RESULTS
  The averaged annual referrals for cardiac surgery at the three hospitals were 846 cases (205 for Chula, 462 for CH and 179 for CMU). Mean age was 4.3 +/- 4.2 years and 51% were male. Follow up data were complete in 96.3%. Surgical procedures were correction of simple shunt lesions (ASD, VSD, AV canal) in 33.9%, close heart surgery (PDA ligation, coarctation repair, BT shunt) in 29.9%, total repair TOF in 19.6%, complex surgery in neonate and infants (arterial switch, TAPVR repair, Norwood procedure, truncus and interrupted aortic arch repair) in 4.2% and others in 12.3%. Median waiting time was 195 days and was significantly different between the three hospitals (p < 0.01). Mortality while waiting were approximately 5% at 2 years at Chula and CH, which was significantly higher than CMU (0%, p = 0.02). Further analysis revealed difference in age (lower Chula than CH than CMU) and types of surgery (more complex at Chula and CH) which may be the causes for difference in the mortality observed.
  
  
  CONCLUSIONS
  Waiting time for cardiac surgery for children in Thailand is long and should be viewed as a problem in public health policy. Optimal waiting time at each hospital may not have to be the same, depending on the type and severity of the disease seen at each particular center Attempt should be made to solve this problem at the national level.
authors.affiliation: Chulalongkorn University, Bangkok, Thailand.
authors.forename: Apichai
authors.initials: A
authors.lastname: Khongphatthanayothin
authors.forename: Thanarat
authors.initials: T
authors.lastname: Layangool
authors.forename: Rekwan
authors.initials: R
authors.lastname: Sittiwangkul
authors.forename: Yupada
authors.initials: Y
authors.lastname: Pongprot
authors.forename: Pornthep
authors.initials: P
authors.lastname: Lertsapcharoen
authors.forename: Pirapat
authors.initials: P
authors.lastname: Mokarapong
mesh_terms: D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility; D006330:Heart Defects, Congenital / Q000401:mortality* / Q000601:surgery; D006760:Hospitalization / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D016019:Survival Analysis; D013785:Thailand / Q000453:epidemiology; D014850:Waiting Lists